Republic of the Philippines)

Province of Albay S.c

Municipality of Camalig )

AFFIDAVIT OF ATTESTATION
I, MONA LISA OKAY, Filipino, single, of legal age, a resident of Barangay Estanza,
Legazpi City, after being sworn to in accordance with law hereby depose and say that:

1. I am the daughter of MICHAEL ANGELO OKAY who was confined in ABC

Hospital;

2. My father signed a Patient Services Application Form dated May 1, 2023 with
the ABC Foundation with his fingerprint;

3. I have witnessed my father voluntarily and freely signed the said document
with his fingerprint;

4. I am executing this Affidavit in compliance with the request of the ABC

Foundation, and I hereby attest to the truth of the foregoing facts and for
whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this 3 rd day of May 2023
at Legazpi City, Philippines.

MONA LISA OKAY

Affiant
PRC License No. 012345

SUBSCRIBED and SWORN to before me this 3 rd day of May 2023 at Legazpi City,
Philippines, affiant showing her valid government-issued ID above-written as
competent proof of identity.

Notary Public

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of _______.

Page 1 of 1