REPUBLIC OF THE PHILIPPINES )

CITY OF GENERAL SANTOS ) SS.

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AFFIDAVIT

I, ______, of legal age, Filipino, widow of ___ and a resident of ____, Philippines,
after having been duly sworn to in accordance with law, hereby depose and say THAT:

1. I am a widow and a survivor heir of ___ who was a member of Personnel of Armed
Forces of the Philippines with a rank of Master Sergeant;

2. Sometime on ___, I was issued with the Armed Forces of the Philippines, Legal
Beneficiary Identification Card wherein the stipulated rank of my husband is
Technical Sergeant;

3. In Special Order No.___issued from the Headquarters Philippine Army, Fort

Bonifacio, Metro Manila, there, being indicated that my husband’s rank is already
Master Sergeant ;

4. I intended to apply for a loan in ACDI Multi-Purpose Cooperative (ACDI for brevity)
but in my record, it was confirmed that my husband’s rank is Master Sergeant
effective upon his death. Thus, I am asked to execute an affidavit to prove that the
indicated rank of my husband in my above mentioned Identification card is just a
typological error and his true rank is Master Sergeant ;

5. I am executing this affidavit to attest to the truth of the foregoing facts and in
support of the application for the issuance of my loan from ACDI.

IN WITNESS WHEREOF, we have hereunto set our hand this __ at General

Santos City, Philippines.

__
Affiant
TIN No. __

SUBSCRIBED AND SWORN to before me, a Notary Public for and in General
Santos City, Phils., this ___ at General Santos City, Philippines, affiant exhibited to me
his competent means of identification as above-indicated and he certified that the
contents hereof are true and correct based on his personal knowledge and authentic
records. He certified that he understood the contents of this Affidavit.

Doc No. __;

Page No. 31;
Book No. LX;
Series of 2019.