REPUBLIC OF THE PHILIPPINES)

_______________________ ) S.S

AFFIDAVIT OF DISINTERESTED PARTIES

We, _____________________ and __________________, are both of legal age, with

residence and postal address at __________________________ after having been sworn to in
accordance with law, do hereby deposes, and say:

1. That we are both disinterested person in the matter stated herein;

2. That we know for a fact that _____________________ was deceased last

_________________ in ____________________;

3. That the facts of his Death Certificate was duly recorded at the Local Civil Registry
of Muntinlupa City;

4. That however after securing his Death Certificate it was found out that his last name
was erroneously recorded therein as ________________ instead of ____________
which is true and correct last name;

5. That __________________ and __________________ refers to one and the same

person;

6. That we execute this Affidavit in order to attest the truth of the above facts for all
legal intents and purposes it may serve.

IN WITNESS WHEREOF, We have hereto set my hands and affix our signature this
_____ day of _________________ at ___________________, Philippines.

_____________________ _____________________

SUBSCRIBED AND SWORN to before me this ____ day of ________________ in

____________________, affiants having exhibited to me their Competent Evidence of Identity:

Name Issued By ID No

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