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2 Disinterested Persons - SAMPLE FORM

1) The affidavit was made by two longtime neighbors and friends of the deceased, Mr. Avelino T. Naparan, who passed away on January 23, 2017 in Baguio City and was survived by his widow and four children. 2) They noticed an error on the Certificate of Death regarding how Mr. Naparan's name was spelled. 3) The affiants state they have no relation or affiliation to Mr. Naparan and are making this affidavit to attest to the truth of the information provided, not for any compensation.

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Moises Fortunato
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52 views1 page

2 Disinterested Persons - SAMPLE FORM

1) The affidavit was made by two longtime neighbors and friends of the deceased, Mr. Avelino T. Naparan, who passed away on January 23, 2017 in Baguio City and was survived by his widow and four children. 2) They noticed an error on the Certificate of Death regarding how Mr. Naparan's name was spelled. 3) The affiants state they have no relation or affiliation to Mr. Naparan and are making this affidavit to attest to the truth of the information provided, not for any compensation.

Uploaded by

Moises Fortunato
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

DONE IN THE CITY OF BAGUIO ) S.c.


X -------------------------------------------------------X

JOINT-AFFIDAVIT OF TWO DISINTERESTED


PERSONS
(Re: Discrepancy on the Certificate of Death and Certificate of Live Birth of ____________)

We, _____________ and ____________ City, Philippines, after having been duly sworn in accordance
with law, hereby depose and state that:
1) We are the longtime neighbors and friends of the late _________________, who died last January 23,
2017 at their home in ____________________, Baguio City, and now survived by her widowed spouse,
________________, and four children. The fact of his death, and other information relating to its
circumstances, was duly registered with the Office of the Civil Registry of Baguio City, as per a
“Certificate of Death” with Registry No. ____________, machine copy of which is hereto attached and
made an integral part hereof;
2) We have come to learn that the Certificate of Death of Mr. __________________ erroneously spells …
3) We are not related by consanguinity or affinity to the late Mr. AVELINO T. NAPARAN, and execute
this Affidavit not for any remuneration whatsoever but to attest to the truth of the foregoing statements.
We execute this Affidavit to attest to the truth of the foregoing facts and for whatever intents and
purpose this may legally serve.
IN WITNESS WHEREOF, we have hereunto set our hand this 3rd day of February 2017 at Baguio
City, Philippines.

______________________ _______________________
Affiant Affiant
Barangay I.D. issued by the Office of the Punong Bureau of Internal Revenue Card
Barangay of Irisan, Baguio City TIN:

SUBSCRIBED AND SWORN TO BEFORE ME, on the same day and place above-written, by the
Affiants whom I have identified through Competent Evidence of Identity, as indicated below their respective names
and signatures.

DOC. NO.
PAGE NO.
BOOK NO.
SERIES OF 2017.

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