Republic of the Philippines )

QUEZON CITY ) SS

AFFIDAVIT OF CONSENT FOR

INTERMENT

We, OFELIA C. CHANG, and ADELIA CHUA CUA, both of legal

age, Filipino citizens and residents of No. 102-C Mother Ignacia St.,
Quezon City, after having been duly sworn to in accordance with law
that:

1) That we are the sisters of the late AMELIA SY CUA;

2) That our sister died on September 9, 2020 at Chinese General

Hospital and Medical CTR;

3) That We hereby give our full consent for her Interment at Holy
Cross Memorial Park at San Bartolome Novaliches, Quezon City

4) That We are executing this affidavit to attest to the truth of the

foregoing facts and for whatever legal purpose this affidavit may
served;

IN WITNESS WHEREOF, We have hereunto affixed our signature

this 24th day of September 2020 in Quezon City, Philippines.

OFELIA C. CHANG ADELIA CHUA CUA

Affiant Affiant
SSS ID Number : 03-3637822-8 Driver’s License Number N04-92-211738

SUBSCRIBED AND SWORN to before me this 24th day of September 2020 in

Quezon City, affiant exhibiting to me their ID Number listed below their names as
proof of their identities..

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of 2020