REPUBLIC OF THE PHILIPPINES )

CITY OF QUEZON ) s.s.

AFFIDAVIT OF CONSENT FOR EXHUMATION AND TRANSFER

I, _____________ Filipino, of legal age, single and residing at _____________,

after having sworn in accordance with the law, do hereby depose and state that:

1. I am the _____________ of _____________;

2. That my _____________ died on _____________ and was interred at

_____________, Quezon City, as evidence by his death certificate;

3. That I have agreed and hereby give my full consent for the exhumation and transfer
of the remains of my _____________ from _____________ to _____________;

4. That I undertake and declare to agree that in the event somebody will question or
claim the remains of my _____________, I will be answerable and liable, and further
declare that the Quezon City Health Department will be free from any liability;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to
support my request with _____________ to allow the exhumation and transfer of the
remains of my deceased husband for whatever legal purpose this affidavit may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS HEREOF, I have hereunto affixed my signature this __ day of

_____________ in Quezon City.

__________________________
Affiant

SUBSCRIBED AND SWORN before me in the City of Quezon, __ day of

_____________ affiant exhibiting to me her _____________ bearing her signature and
photograph.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018