Republic of the Philippines)

Province of Negros Oriental..) S.S.

Municipality of Sibulan)

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

That we, VITALINA B. ORCIA, 84 years old, married, of legal age, Filipino, and resident of
Ajong, Sibulan, Negros Oriental, and TITO C. PIALAGO, 87 years old, married, of legal age,
Filipino, and resident of Ajong, Sibulan, Negros Oriental, under oath, do hereby depose and
manifest:

That we have personally known the person of the late AGRIPINA CALIT BALBUENA.

That we also know that AGRIPINA CALIT BALBUENA was born on November 30, 1888 at
Sibulan, Negros Oriental, to CATALINA CALIT, her mother, and TEODORO ASIS, her father;

That we also know that AGRIPINA CALIT BALBUENA died sometime on March 29, 1953 in
Ajong, Sibulan, Negros Oriental;

That we learned that AGRIPINA CALIT BALBUENA’s birth and death was not registered
with the Local Civil Registrar, Philippine Statistics Authority (PSA), or National Statistics Office
(NSO);

That we know the circumstances of birth and death of AGRIPINA CALIT BALBUENA
because we are acquaintances for quite a long time already until the present, and that neither of us is
related with her either by affinity or consanguinity and that we are executing this joint affidavit
freely and voluntarily in order to attest to the veracity of the facts above-stated and for whatever
legal purposed this may serve best;

IN WITNESS WHEREOF, we have hereunto affixed our signatures this _________________, at

Sibulan, Negros Oriental.

VITALINA B. ORCIA TITO C. PIALAGO

(Affiant) (Affiant)
ID: OSCA ID No. 0284 issued on ID: OSCA ID No. 0282 issued on
03/24/2021 in Sibulan, Negros Oriental 06/23/25 at Sibulan, Negros Oriental

SUBSCRIBED AND SWORN to before me this ___________________, in Sibulan, Negros

Oriental, Philippines, personally appeared the above-named persons and exhibited to me their
respective proofs of their identity written below their respective name and signature, that they are
the same persons who appeared and signed the foregoing Joint Affidavit of Two Disinterested
Persons in my presence within my jurisdiction, and who avowed to the truth of its content under
penalty of law.

Doc No. _________;

Page No. ________;
Book No. ________;
Series of 2021.