AFFIDAVIT OF GUARDIANSHIP

I, Lourraine Benemerito Soledad, of legal age, Filipino, married and with

residence and postal address at Purok 2, Lanao, Kidapawan City, after being duly
sworn to in accordance with law, depose and state that:

1. I am the mother of the minor named below who is the beneficiary in the
Mortuary Claim/Death Benefit Claim of the late Inez T. Benemerito payable
by the Mediatrix Multi – Purpose Cooperative, Kidapawan City.

NAME OF MINOR DATE OF BIRTH AGE

KYCE ANGELIKA BENEMERITO CASTEN DECEMBER 27, 2006 14

2. I am the guardian of the above-named minor;

3. The said minor is under my care and custody;

4. I am competent to receive on behalf of the said minor any

amount/benefit/proceeds due her;

5. I have not been diagnosed nor committed to a hospital or institution for

imbecile, insane, a vagrant or vicious person. I am not a habitual drunkard or
a habitual criminal, and have not abandoned, neglected, or refused to support
said minor or caused her to commit offenses against the law; and

6. I am executing this affidavit to confirm and affirm the foregoing facts and to
prove that I am the legal guardian of the above-named minor, and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this day of

, 20 at .

LOURRAINE B. SOLEDAD
Affiant

SUBSCRIBED AND SWORN to before me in the

this day of , by , who has
satisfactorily proven to me her identity through her
, valid until , that she is the
same person who personally signed before me the foregoing Affidavit of Guardianship
and acknowledged to me that she executed the same.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2021.