Republic of the Philippines)

Province of Quirino) S.S.

Municipality of Diffun
x------------x

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, RELITO AMBROCIO VIERNES, of legal age, Filipino citizen, and

presently residing at Brgy. Turod Sur, Cordon, Isabela and MELBA LAGGAO
OCHULLOM, of legal age, Filipino citizen, and presently residing at Brgy. Turod
Norte, Cordon, Isabela, under oath and state:

1. That we are the very same persons executing the foregoing;

2. That we attest to the fact that the person in the name of LINSAY DELA
CRUZ BALAJO as stated in a Policy Contract bearing Policy No.
1018191849 issued by PHILAM LIFE and the person in the name of BEA
LINSAY DELA CRUZ BALAJO who was born on 30 January 2014 at
Santiago City, Isabela as correctly stated in her Certificate of Live Birth
issued by Philippine Statistics Authority (PSA) refer to one and the same
person;

3. That we are not in any way related to any of the foregoing person within
the fourth civil degree either by consanguinity or affinity, nor do we have
any pecuniary interest in this matter whatsoever;

4. That we are executing this instrument to attest to the truth of the foregoing
statements and for whatever legal purposes and intents this may worth.

IN WITNESS WHEREOF, we have hereunto set our hands this 6th day of
May, 2021 at Diffun, Quirino.

RELITO AMBROCIO VIERNES MELBA LAGGAO OCHULLOM

Affiant Affiant
Driver’s License No. B12-08-001153 TIN: 423-978-545
Valid until 2021/10/07 Issued on 08/07/2018

SUBCRIBED AND SWORN TO before me this 6th day of May, 2021 at

Diffun, Quirino, Philippines, by affiant/s who is/are personally known to me and
personally signed the foregoing instrument before me and avowed under penalty of
law to the whole truth of the contents of said instrument.

Doc. No. 217;

Page No. 44;
Book No. XXIX;
Series of 2021.