Republic of the Philippines)

Province of Southern Leyte…) S.S

City of Maasin)

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, ABIGAEL CERRO and ANGEL RAMAYLA, both of legal age, Filipinos, married, and
residents of Brgy. Canturing, Maasin City, Southern Leyte, after having been duly sworn to
in accordance with law, do hereby depose and state;

1. That we personally know the identity of ASUNCION D. BLANCO, Brgy. Canturing,

Maasin City, Southern Leyte, being the mother of the late EUSTAQUIA BLANCO
MONTE DE RAMOS, also of Brgy. Canturing, Maasin City, Southern Leyte;

2. That the designated beneficiary of the deceased insured has a pending Death Claim
Application;

3. That the said application is required to be accompanied by a copy of the deceased’s

death certificate, however, no record can be obtained, as shown by the attached
Certification of Non-Availability of Birth Record from the National Statistics Office
(NSO);

4. That further, no record of her death can also be obtained at the Local Civil Registrar
of the Municipality of Sogod, Southern Leyte;

5. That we attest that she died on January 22, 1961 at Sogod, Southern Leyte;

6. That we know the fact of the above-named persons because we are close friends of
the family;

7. That we are not related to them within the fourth civil degree, either by affinity or
consanguinity;

8. That we are executing this affidavit to attest to the veracity of the foregoing facts
and for any legal purpose this may serve thereby.

             IN WITNESS WHEREOF, we have hereunto affixed our signatures this ______________
at Maasin City, Southern Leyte, Philippines.

ABIGAEL CERRO ANGEL RAMAYLA

AFFIANT AFFIANT

SUBSCRIBED AND SWORN TO before me this _______________ at Maasin City, Southern

Leyte, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2018