AFFIDAVIT OF KINSHIP
I, (Name nung pinaka malapit na kamag-anak na nagpapanotaryo) , of legal age, single/married,
Filipino and a resident of (Address nung nagpapanotaryo), after having been duly sworn to in
accordance with law, do hereby declare and state THAT:
1. I am the only surviving kin of the late (Name nung namatay), of (Address nung namatay),
Philippines.
2. (Name ng namatay) is my (relationship ng namatay sa nagpapanotaryo)
3. My _____________ was never married and he had no known child during his lifetime
(confirm mo to kung ito ang situation nila or if the dead person has no more surviving relatives
except for the affiant) ;
4. Further, I am executing this Affidavit of Kinship to support my request/application with the
Philippine Statistics Authority (PSA) for the issuance of my (Name ng namatay)’s (Kung anong
document irerequests a PSA);
5. I hereby undertake to be solely responsible for the contents of my Affidavit in case of any
resulting damage or prejudice and hereby further hold the government or PSA free therefrom;
6. Finally, I am executing this Affidavit of Kinship to attest to the truthfulness of the foregoing
facts and for all legal intents and purposes this may serve well;
IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of ____________, 2020
in Bayambang, Pangasinany, Philippines.
_____________(NAME)___________
Affiant
ID No. _______________
Expiring on: ___________
SUBCRIBED AND SWORN TO before me this ___________________ in _Bayambanag,
Pangasinan Philippines, affiants exhibiting to me their valid proofs of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2020