Republic of the Philippines )

Province of Cagayan )
Municipality of Alcala ) S.S.

AFFIDAVIT OF LEGAL BENEFICIARY

We, WILHELMINA GALASINAO ARCILLA, married and NELIE G.

VILLASPIN, widow, both Filipino citizens, of legal age, and presently
residing at District I Cauayan City and Centro Sur, Alcala, Cagayan
respectively, after being duly sworn to in accordance with law, depose and
state that:
1. That we are the beneficiary of the deceased DOMINADOR
LABRADOR GALASINAO, who was a member of the Social Security
System;

2. That we are the siblings/closest surviving relative or the decedent, or

the appointed beneficiary of the estate of the decedent;

3. That we have a legal claim to all benefits of our deceased brother;

4. That we are executing this Affidavit and for whatever legal purpose it
may serve.

IN WITNESS WHEREOF, we have hereunto set forth our hand this 17 th

day of January 2022 in Alcala, Cagayan.

WILHELMINA G. ARCILLA NELIE G. VILLASPIN

Affiant Affiant
ID: Senior Citizen 18505 ID: Senior Citizen 19-09-6492

SUBSCRIBED AND SWORN to before me this 17 th day of January 2022 in

Alcala, Cagayan.

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Series of 2022.