REPUBLIC OF THE PHILIPPINES )

___________________________ ) S.S.

AFFIDAVIT OF NO RELATION

I, <name>, of legal age, Filipino citizen with principal address at <address>, after
having been duly sworn to in accordance with the law, hereby depose and state that:

1. I have no relatives by consanguinity nor affinity within the fourth (4th) civil
degree currently employed in the <name of agency>;
2. I am executing this Affidavit to attest to the truth of the foregoing and for
whatever legal purpose/s this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this __ day of __, 2017
at ____________ City.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ______________

________, Affiant exhibited to me his ___________________________, a
government-issued ID with number ___________________, bearing his photo and
signature, expiring on ____________________.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of _____.