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Republic of the Philippines)

City of Santiago ) Sc.


x-----------------x

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, _________________ and _________________, both Filipinos, of legal ages, and


residents Calao East, Santiago City, Philippines, having been duly sworn to in
accordance with law, hereby depose and state:

1. That we both personally know the person of ________________________, over a


long period of time because we live in the same locality, and his family is a close
family friend for several years now;

2. That we also know and we hereby declare that the said ________________________
is married to ______________ and died on ____________________;

3. That we know for a fact that said person by the name of ____________________ as
known by many, and ________________ as appearing in her authenticated death
certificate issued by the National Statistics Office, refer to one and the same
person;

4. That we are not related in any way, either by consanguinity or affinity, to the
said _________________;

5. As such, we execute this Affidavit to certify or attest to the truth of the foregoing
facts and for whatever legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, we have set our hands this 4th day of October, 2005 at
Santiago City, Philippines.

_____________________ _____________________
Affiant Affiant

SUBSCRIBED AND SWORN to before me, this 4th day of October, 2017 at
Santiago City, Philippines, by the Affiants with their competent evidence of identity,
both of whom are personally known to me.

Notary Public

Doc. No. 1;
Page No. 1;
Book No. I;
Series of 2005.

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