REPUBLIC OF THE PHILIPPINES )

CITY OF SAN CARLOS PANGASINAN) S.S.

AFFIDAVIT

I, LEONOR VALDEZ FERRER, of legal age, widow, Filipino citizen, and a resident
of Brgy. Obong, Basista, Pangasinan, Philippines, after having been duly sworn to in accordance
with law, do hereby state that:

1. I am the sister of the deceased ALDO GLORIA VALDEZ who died on April 10,
2020, at Brgy. Obong, Basista, Pangasinan;

2. To fulfill one of the prerequisites for his SSS death claim, I have requested his
Certificate of Death from the Basista, Pangasinan, Local Civil Registry;

3. That my sister CHARITO GLORIA VALDEZ and I are the only living nearest
of kin of the deceased; and

4. I execute this affidavit to attest to the truth of all the foregoing statement and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________at San

Carlos City, Pangasinan.
_______________________
LEONOR VALDEZ FERRER,
(Affiant)
OSCA ID NO.: 2021-3347

SUBSCRIBED AND SWORN to before me this ________________ at San Carlos City,

Pangasinan.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2023