Republic of the Philippines )

Province of Davao Del Norte )

City of Tagum )s.s
x-------------------------------x

AFFIDAVIT OF KINSHIP
I, ____________, 38 years old, Filipino, single, and a resident of
_________, Philippines, after having been duly sworn to in accordance with
law, do hereby depose and state THAT:

1. I am the same person whose circumstances stated above;

2. I personally know _________ who died last _________ because we

lived together as husband and wife without the benefit of marriage
for seven (7) years before he died;

3. During our cohabitation, we begot two (2) minor daughters namely:

_________________ and ___________________;

4. I am in the process of collating the documents needed in support of

my children’s claims and benefits in behalf of their deceased father;

5. I am executing this affidavit to attest to the truth of the foregoing

statement and in support of my intention to secure a copy of
Certificate of No Marriage (CENOMAR) of my deceased common law
husband;

6. I further execute this affidavit to attest to the truthfulness and

veracity of my statement above.

IN WITNESS WHEREOF, I hereunto set my hand this

_________at________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this_________, at

__________, Philippines, affiant exhibiting to me her competent evidence of
identity written below her name and signature.