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Republic of the Philippines )

City of Dumaguete ) s.s.



I, ARLENE ENTAC-ESTARIS, of legal age, married and resident of Brgy. Upper Luke
Wright, Dumaguete City, Negros Oriental, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state that:

1. I am a regular member of Dumaguete Cathedral Credit Cooperative-Main Branch,

Dumaguete City, Negros Oriental, Philippines, and maintaining in the said office a
Passbook with passbook number #7213;

2. Sometime in 1993 when I applied with DCCCO-Main Branch, I have constituted and
designated my husband, GERRY D. ESTARIS, as one of my beneficiaries aside from
JAHARRA E. ESTARIS, my daughter;

3. Sometime in 2003 when my husband, GERRY D. ESTARIS, was working in Saudi

Arabia as Electric Engineer, I had discovered that he was maintaining an illicit
relationship with another woman, and until the present, he is cohabiting with the
said woman whose name is unknown to me;

4. In view of his being designated as beneficiary, he is entitled to claim for any

proceeds under the DAMAYAN which partakes the nature of an insurance policy;

5. Having given ground to lose my love and trust upon my husband who acted in bad
faith, I have decided to update my status as member of DCCCO-Main Branch by
voluntarily revoking the designation of my husband as one of the beneficiaries; and

6. I am executing this Affidavit in good faith to attest to the truthfulness of the

foregoing facts in support of my application to change and revoke the designation of
my husband as beneficiary, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 23th day of

August 2017 at Dumaguete City, Negros Oriental, Philippines.


SSS ID 08-0926707-3

SUBSCRIBED AND SWORN to before me, a Notary Public in and for Dumaguete
City, Negros Oriental this 23th day of August 2017. The Affiant, whom I identified through
her competent evidence of identity written below her name, personally signed the
foregoing instrument before me and avowed under penalty of law to the whole truth of the
contents of said instrument.

Doc. No. ___________;

Page No. ___________; NOTARY PUBLIC
Book No. __________;
Series of 2017.