REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LANAO DEL NORTE ) S.S

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AUTHORIZATION

I, JONATHAN, Filipino, of legal age, married, and a resident of ________,

Lanao del Norte, Philippines, after having duly sworn in accordance with law,
do hereby depose and state that:

1. I am the husband of late ___________, who was born on _________ and

died on ____________ due to Breast Cancer IV at hospital;

2. That late __________________ was a member of Pantawid Pamilyang

Pilipino Program (4P’s), _________, Lanao del Norte;

3. Considering the untimely death of my wife, I am the authorized

person to claim the 4P’s beneficiary in her behalf;

4. I am executing this Affidavit to the truth of the foregoing statements

and for whatever legal purpose it may serve;

FURTHER, I SAYETH NAUGHT

IN WITNESS WHEREOF, I have hereunto affixed my hand this ___ day of

August 2023 at ______, Lanao del Norte, Philippines.

JONATHAN
Affiant

SUBSCRIBED AND SWORN TO before me this __ day of August 2023 at

_______, Lanao del Norte, Philippines, with affiant exhibiting to me his ID
______with No ________.