Affidavit Template.docx

Republic of the Philippines) ) SS. AFFIDAVIT re: ART PROVENANCE I, name, of legal age, married, and a resident of address hereby depose and state that: 1. The Untitled Artwork as shown below has the following details:

a. b. c. d.

Artist : Size : Medium : Circa :

2. Details. 3. Details. 4. I affirm, confirm, and undertake that all stipulations above are true and correct to the best of my personal knowledge. 5. I execute this Affidavit to attest the veracity of the contents hereof and for all legal intent and purposes it may serve. AFFIANT SAYS NOTHING FURTHER

Name Witness

Name Affiant

SUBSCRIBED AND SWORN TO before me this__________ day of_______________ at City of _______________, affiant exhibiting to me his Driver’s License with License number ID Number.

Notary Public Doc. No. .........: Page No. .........; Book No. .........; Series of 20__.