REPUBLIC OF THE PHILIPPINES )

AFFIDAVIT OF TWO (2) DISINTERESTED PERSONS

WE, _________________, both of legal ages, both widow, both are presently residing at
_______________, after having been sworn to in accordance with law hereby depose and state,
THAT:

1. We know personally ______________who was born on November 14, 1939.

2. We also knew for a fact that her name was registered in various government agencies
(Commission on Election Office and Office of the Senior Citizens Affairs) as
_____________and her name in Transfer Certificate of Title No. __________ is
_______________, to wit:

“______________, of legal age, married to _______________, Filipino x xx”

3. We also knew for a fact that her registered name in their marriage contract is
____________.

4. The name ______________and ____________ refers to one and the same person.

5. _____________ is the true and correct name and that _____________ was mere
inadvertent mistake.

6. These facts, are of our own true and personal knowledge, for we are barangay mates of
the late _______________.

7. We are not her relatives, either by affinity or consanguinity and that we executed this
affidavit without promise of reward and that we will not be benefited for its execution.

IN WITNESS WHEREOF, WE have hereunto affixed our signature this __________________

at _______________.

_______________ ___________________
Affiant Affiant
ID NO. ID NO.
Issued by: Office of the Senior Issued by: Office of the Senior
Citizens Affairs Citizens Affairs

SUBSCRIBED and SWORN to before me this _______________ at

_________________, personally appeared the above-named parties known to me to be the same
persons and ascertained their identities after presentation of various identification cards and
acknowledged to me that that the same are their own, free, voluntary act and deedand I further
certify that they have read the contents of their affidavit and that they understood the same.

Doc no.____;
Page No.___;
Book No.___;
Series of 2019