Sample form : AFFIDAVIT OF FUNERAL EXPENSES

REPUBLIC OF THE PHILIPPINES )

                                                            :  S.S.

______________________)

 AFFIDAVIT OF FUNERAL EXPENSES

            I, JUAN DELA CRUZ, of legal age, married, Filipino with residence and postal address at  __________________, after being duly sworn to in accordance with law, hereby depose and state:

1.         That I know the fact of death of the deceased, ______________, who died at _________ on ______________ because _____________;

2.         That during the wake, I actually defrayed the following expenses to wit:

a.__________________                                               - P _______

b.__________________                                               - P _______

c.__________________                                               - P _______

d.__________________                                               - P _______

e.__________________                                               - P _______

f.__________________                                                - P _______

g.__________________                                               - P _______

h.__________________                                               - P _______

        TOTAL                                                     = P________

3.         That I am executing this affidavit to attest to the truth of  the foregoing statements and for the purpose of filing Funeral Expense Reimbursement claim from _______________________.

FURTHER,      affiant sayeth none.

                                                                         _____________________

                                                                                        Affiant

            SUBSCRIBED AND SWORN TO before me this ____ day of _________ at ______________, Philippines, affiant  having exhibited to me her Residence Certificate No. ______________  issued at _____________ on _________________.

                                                                           ______________________

                                                                                    Notary      Public

Doc. No ________                                            Until Dec. 31, 20 ________

Page No. _______                                             PTR no. _______________

Book No. _______                                            Issued at ______________

Series of   2011

Note: The above sample format of Affidavit of Funeral Expenses is posted in an effort to share to individuals who might need this.  At  one point in my life, this form was a "help" to my family in need.