REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF CONSENT FOR EXHUMATION AND TRANSFER

I, [NAME], Filipino, [AGE] years old, [CIVIL STATUS], and residing at [ADDRESS], after having
sworn in accordance with the law, do hereby depose and state:

1. That I am the biological son of the late [NAME OF DECEASED], who died on [DATE OF DEATH]
at [PLACE OF DEATH] and is buried in [NAME OF CEMETERY/BURIAL PLACE];

2. That together with my siblings [IF THERE IS], we agree that the remains of our mother/father
[NAME] will be exhumed from [NAME OF ORIGINAL CEMETERY/BURIAL PLACE] and her
remains will be transferred to [NAME OF CEMETERY/BURIAL PLACE];

3. That I hereby undertake and declare to agree that in the event that somebody will question or claim the
remains of my deceased mother/father who was buried in the aforesaid cemetery, I will be answerable
and liable and further declare that Quezon City Health Department will be free from any liability;

4. That I hereby declare that [NAME OF THE ORIGINAL CEMETERY/BURIAL PLACE] and its staff
shall not be liable to any person who may present a lawful claim on the above transactions and I
undertake to indemnify any such person who shall make a lawful claim on the same;

5. That we have executed this affidavit to attest to the truth and veracity of all the above statements, for
all legal intents and purposes this may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS HEREOF, I have hereto affixed my signature this [DATE] in Quezon City.

[NAME]
Affiant

SUBSCRIBED AND SWORN before me in Quezon City, this [DATE], affiant exhibiting to me his
[TYPE OF ID] and [ID NUMBER] bearing his/her photograph and signature.

Doc. No. ____;

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