Republic of the Philippines…}

Province of Surigao del Sur…}

City of Tandag…} S. S.

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, FELIPE P. PLAZA and NALEJO N. ANUB, both of legal age, both married
and residents of Tandag City, Surigao del Sur, state under oath, THAT:

1. We personally know the late EUSEBIA MAHINAY MAHOMOC, being our

friend, for not less than 30 years while she was living;

2. We know her fact of birth, family background and correct spelling of her full
name as EUSEBIA MAHINAY MAHOMOC;

3. However, in the Certificate of Death of her daughter, CONCHITA QUIֹÑONEZ

BAGWASAN, Eusebia’s surname was misspelled as “MAHUMOK” instead of
“MAHOMOC”;

4. We attest that the names EUSEBIA MAHINAY MAHOMOC, reflected in the

Marriage Contract between Sotero C. Bagwasan, Jr. and Conchita M. Quiñonez, and
the EUSEBIA MAHINAY MAHUMOK reflected in the Death Certificate of Conhita
Quiñonez Bagwasan refer to one and the same person;

4. We are executing this Affidavit to apprise the Office of Civil Registrar General
of said discrepancy, to request that the name EUSEBIA MAHINAY MAHUMOK be
changed and reflected as EUSEBIA MAHINAY MAHOMOC, and for whatever legal
purpose this may serve best.

IN WITNESS WHEREOF, we have hereunto set our hands this 28th day of
December 2014, in Tandag City, Surigao del Sur, Philippines.

FELIPE P. PLAZA NALEJO N. ANUB

Affiant Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and in the
Province of Surigao del Sur, this 28 th day of December 2014, in Tandag City, Surigao
del Sur, the affiants personally appeared and affixed their signature and presented their
IDs as proofs of their identities.

ANDREI ARREZA ANDRESAN

Notary Public
IBP No. 811317/ Jan.8, 2014; Surigao del Sur
PTR No. 4936048/ Jan.6, 2014; Surigao del Sur
IBP Roll No. 41883
Misc. Case 05 2014
MCLE Compliance No. IV- 0013490

Doc. No. _____; Page No. _____; Book No. _____; Series of 2014.