AFFIDAVIT OF SOLE BENEFICIARY

I, ANGELICA MARIE ANSIS APOLTO, of legal age, Filipino, single and

with address at Block 6 Lot 5 Montefaro West Village Alapan 1-B, Imus, Cavite,
under oath hereby depose and state, that:

1. I am the only surviving heir of my late mother, ANALIZA ANSIS

APOLTO, who died intestate in RS Dr. OEN Solo Baru, Perumahan Solo Baru
KEC. Grogol Sukoharjo, Indonesia, on 08 July 2021, as evidenced by her
Certificate of Death issued by RS Dr. OEN Solo Baru, hereto attached as Annex
“A” and made an integral part of this Affidavit;

2. I am the only child of ANALIZA ANSIS APOLTO. Likewise

attached in my affidavit is my birth certificate as Annex “B”, to prove that I am
the only heir of my mother, ANALIZA ANSIS APOLTO.

3. On 30 April 2002, the marriage of my parents was declared null

and void ab initio for being bigamous. A copy of the Decision dated 30 April 2002 is
attached hereto as Annex “C”.

4. All of these will prove that I am the only surviving heir and
beneficiary of my late mother, ANALIZA ANSIS APOLTO.

5. I am executing this Affidavit to attest to the foregoing and that the

same are true and correct based on my personal knowledge and understanding.

IN WITNESS WHEREOF, I have hereunto set my hand this 5th of August

2021 in Imus, Cavite.

ANGELICA MARIE ANSIS APOLTO

Affiant

SUBSCRIBED AND SWORN to before me this _____________ in

_________________________. Affiant was identified by me through competent
evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M. No.
02-8-13-SC), particularly exhibiting her __________________________.

Doc. No. _____;

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