AFFIDAVIT OF CLAIMANT

I, CARLITO C. PENTIN, Filipino, of legal age, widower and a resident of Brgy.

Kauswagan, Malitbog, Southern Leyte, Philippines, having been duly sworn in accordance with
law, hereby depose and state:

That I am the spouse of the deceased LUCIA B. PENTIN, who was born on December
22, 1959 at Brgy. Kauswagan, Malitbog, Southern Leyte;

That I my wife LUCIA B. PETIN died last January 24, 2021 in Brgy. Kauswagan
Malitbog, Southern Leyte;

That I at the time of her death she was a resident and the incumbent Punong Barangay of
Brgy. Kauswagan, Malitbog, Southern Leyte;

That the deceased left an estate of minimal value which is not under administration from
anybody and she did not left a will upon her death;

That the surviving legal heirs of the deceased at the time of his death are the following:

1. CARLITO C. PENTIN – widower

2. RACKY B. PINTIN
3. MINERVA B. PENTIN
4. RANDO B. PENTIN
5. MALOU B. PENTIN
6. NEL B. PENTIN
7. CARLITO B. PINTIN JR.

That all the children of the deceased has no legally adopted/acknowledged natural child
and illegitimate child;

That there are no minor children who have interest in the proceeds of the benefits due
to the deceased and payable by the DILG;

That I am executing this affidavit to attest to the truth of the foregoing statements and for
whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto set our hands this _________________ at

Tomas Oppus, Southern Leyte, Philippines.

CARLITO C. PENTIN
AFFIANT
OSCA ID NO. 2582

SUBSCRIBED AND SWORN TO before me ________________ at Tomas Oppus,

Southern Leyte, Philippines.