Republic of the Philippines )

Province of Davao Del Norte )

City of Tagum )s.s
x-------------------------------x

AFFIDAVIT OF COMMON LAW WIFE

I, ELEONOR L. DINLAYAN, _____years old, Filipino, and a resident
of _________, Philippines, after having been duly sworn to in accordance
with law, do hereby depose and state THAT:

1. I am the same person whose circumstances stated above;

2. I personally know SAMUEL ADAYA who died last _________

because we lived together as husband and wife without the benefit
of marriage for seven (7) years before he died;

3. During our cohabitation, we begot two (1) minor son

______DODONG_______

4. I am in the process of collating the documents needed in support

of my children’s claims and benefits in behalf of his deceased
father;

5. I execute this affidavit to attest to the truthfulness and veracity of

my statement above and for whatever legal purpose this may serve
.

IN WITNESS WHEREOF, I hereunto set my hand this

_________at________, Philippines.

ELEONOR L. DINLAYAN
Affiant

SUBSCRIBED AND SWORN to before me this_________, at

__________, Philippines, affiant exhibiting to me her competent evidence of
identity written below her name and signature.