Republic of the 

Philippines )
City of Quezon                    ) SS.
x- - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF SURVIVING SPOUSE/ HEIRS

I, MIRA FAITH ALLEGRE PASCUAL,  of legal age, Filipino citizen and resident of

____________Quezon City Philippines, after having been duly sworn to in accordance
with the law, depose, and state that:

1. That I, Mira Faith Allegre Pascual is the surviving spouse of the deceased Richard
Pascual who died on 5 October 2020 at _________ City, Philippines.

2. That we are blessed with a son who is ___ years old named Lucanus Pascual.

3. That we are the surviving legal heirs of the deceased Richard Pascual.

4. That I am executing this affidavit to attest to the truth and veracity of the foregoing
facts and for all legal intents and purpose that it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this ___ day of October
2020 in the City of Quezon,  Philippines.

Mira Faith Allegre Pascual

Surviving Spouse of the Deceased Richard Pascual
UMID No. _____________________

SUBSCRIBED AND SWORN to before me this _____ day of October 2020 in the City

ofQuezon, Philippines, affiants exhibited to me their government-issued IDs as valid proofs
of identity.

Notary Public
Doc. No.
Page No.
Book No.
Series of 2020.