Republic of the Philippines)

Province of Surigao del Sur)

Municipality of Tago) s.s.
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AFFIDAVIT OF TWO DISINTERESTED PERSONS

WE, SANDAE B. LICO and EMELYN M. DUBLAS, both of legal ages,

Filipinos, and residents of Cortes, Surigao del Sur, Philippines, after having been
duly sworn to in accordance with the law, depose, and state:

1. That we personally know RAMIL BERONGAN GALVANO, who

was born on June 22, 1986 at Cambatong, Hinatuan, Surigao
del Sur, to the spouses Elcita Berongan and Alejandro Galvano;
he had been our neighbor and our close friend;

2. That in his Certificate of Live Birth issued by the Local Civil

Registrar of the Municipality of Hinatuan, Surigao del Sur, his
middle name was erroneously entered therein as BERANGAN,
instead of BERONGAN, which is his true and correct middle
name as indicated in his record at PhilHealth;

3. That also in the Certificate of Live Birth of RAMIL BERONGAN

GALVANO, the last name of her mother’s maiden name was
erroneously entered therein as “BERANGAN”, instead of
“BERONGAN” which is the true and correct spelling of her
mother’s last name;

4. That we hereby attest that the names RAMIL BERANGAN

GALVANO, indicated in his Certificate of Live Birth; and RAMIL
BERONGAN GALVANO, indicated in his record at PhilHealth,
refer to one and the same person;

5. That we are not in any way related to RAMIL BERONGAN

GALVANO within the fourth civil degree either by consanguinity
or affinity, nor do we have any pecuniary interest in this matter
whatsoever;

6. That we are executing this Affidavit to attest the veracity of the

foregoing and for all legal intents and purposes it may serve
best under the circumstance.

IN WITNESS WHEREOF, we have hereunto set our hands this 15 th day of

January, 2021 at Tago, Surigao del Sur.

SANDAE B. LICO EMELYN M. DUBLAS

Affiant Affiant
I.D. No. 20-0006-R PhilHealth I.D. No. 18-000025886-3

SUBSCRIBED AND SWORN to before me this 15th day of January, 2021

at Tago, Surigao del Sur.
ATTY. RONALD I. MAGALLANO
Notary Public
Doc No. ____ Under Serial No. SDS-07-2020
Page No. ___ Until December 31, 2021
Book No. ____ Roll of Attorneys No. 67773
Series of 2021. PTR No. 9109017 - 1/05/21
IBP No. 150721 – 1/13/21
MCLE Compliance No. VI-0012494