Republic of the Philippines)

Province of Negros Ofriental)s.s.

Municipality of Sibulan….)

AFFIDAVIT OF HEIRSHIP WITH SPECIAL POWER OF ATTORNEY

THAT WE, GUILLERMO FORTUITO, VENUSA M. BONILLA, TEODULA M.

CARBAJOSA, and NILA M. DICEN, all of legal age, Filipinos, married; and residents of
barangay Magatas, Sibulan, Negros Orientgal, under oath, do hereby depose and manifest:

That WE are the children of the late FELIPA F. MAPUTI who died last June 13, 2013 in
barangay Magatas, Sibulan, Negros Oriental;

That during her lifetime she was a member of the COCOLIFE Insurance Corporation
under Certificate Of Group Life Insurance No. 276479;

That Felipa Fortuito Maputi died intestate sometime in June 13, 2013 leaving without any
testamentary will nor debts m not settled until the present and upon her death she was survived
by her children and only compulsory Heirs, namely: GUILLERMO FORTUITO, VENUSA M.
BONILLA, TEODULA M. CARBAJOSA and NILA M. DICEN;

That invoking the provisions of Section 1, Rule 74 of the Rules of Court and all pertinent
laws on succession, the herein affiants, do hereby settle and adjudicate unto themselves as co-
owner of the proceeds of the aforementioned Cocolife Insurance;

That by virtue of these deed, we have also appoint and constitute our sister, NILA M.
DICEN, to be our true and lawful attorney in fact to get, received and signed all pertinent papers
regarding the release of the said Insurance and giving and granting unto our Attorney In fact, full
power and authority to do and perform each and every act necessary inorder to give full effect of
the foregoing authority as fully to all intents and purposes as we might be or could lawfully do,
if personally present;

That this affidavit is executed freely and voluntarily and to attest the veracity and
truthfulness of all the allegations stated herein.

IN WITNESS WHEEOF, I have hereunto affixed my signature this ___day of June 2013,
at Sibulan, Negros Oriental.

GUILLERMO FORTUITO VENUSA M. BONILLA TEODULA . CARBOJOSA

(Affiant) (Affiant) (Affiant)
CTC No. _____________ CTC NO. ____________ CTC No. ______________
Issued 0n _____________ Issued on ____________ Issued on ______________
At ___________________ At__________________ At ____________________

NILA DICEN
(Affiant)
CTC NO. _____________
Issued on _____________
At____________________

SUBSCRIBED AND SWORN to before me, this ___day of June 2013, at Sibulan,
Negros Oriental, affiants exhibited their respective identification papers printed below their
respective names.

TIRSO F. BANQUERIGO
JUDGE