Republic of the Philippines)

City of Pagadian………….) S. S.
x-------------------------------------------x

AFFIDAVIT OF SURVIVOR

I, EVELYN PERIGRINO, Filipino of legal age, widow and a resident of

Poblacion San Miguel Zamboanga del Sur, after having been sworn to in
accordance with law hereby depose and say THAT:

1. I am the surviving spouse of the late FELIX TAMSI who died on June 18,
2009;

2. The late Felix Tamsi was an employee of the Local Government Unit of San
Miguel and as such a member Government Service Insurance System with
Certificate of Membership No. 5603669;

3. As member of GSIS Felix Tamsi has Life Insurance Policy No.

50070802446;

4. I am the surviving spouse having married to Felix Tamsi on October 28,

1978 as evidence by our Marriage Contract;

5. As of now, I am not married to anybody other than my husband the late

Felix Tamsi;

6. I am dependent of the late Felix Tamsi for I have no work and is a plain
housewife;

7. Finally I am executing this affidavit to attest to the truthfulness of the

foregoing and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 14 th day of July

2009 at Pagadian City, Philippines.

EVELYN PERIGRINO TAMSI

Affiant
 SUBSCRIBED AND SWORN TO, before me this 14 TH day of July 2009 at
Pagadian City, Philippines.