Republic of the Philippines)

Province of Surigao del Norte)

Municipality of Claver) S.S.
x ---------------------------------x

AFFIDAVIT OF EXPLANATION

I,CLARITA DAGASDAS, of legal age, Filipino citizen, widow and a

resident of Brgy. Urbiztondo, Claver, Surigao del Norte, after having been duly
sworn in accordance with law, do hereby depose and state:

1. That I am the mother of JACKQUILINE DAGASDAS and JOSEPH

DAGASDAS;

2. That both my children died at birth;

3. That their death certificates were not procured due the reason that they
were also not registered in the civil registry;

4. That in the SSS form written by my deceased husband TRANQUILINO

DAGASDAS, both of my deceased children was MISTAKENLY included as
beneficiaries even if they are both dead already;

5. That at present, my living children are only four in the names of Rafael
Dagasdas, Gina Asuncion Dagasdas, Genajen Dagasdas and Zenny Joy
Dagasdas;

6. That I am executing this Affidavit of Discrepancy to attest to the truth of

the foregoing facts and to explain the discrepancy of my first name.

IN WITNESS WHEREOF, We have hereunto set our hands on this 20TH day of
December 2019, at Surigao City, Philippines.

CLARITA DAGASDAS
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 20th day of December 2019,

Affiant personally presented to me her LGU ID bearing the number STF-050-2019, as
valid and acceptable proof of his identity.

ATTY. RICHELLE B. DEDUMO

Notary Public until December 31, 2020
Roll No. 72749
IBP No. 089097 dated June 10, 2019
PTR No. 1059708 dated June 20,2019
MCLE Exempted: Admitted to the Bar June 17, 2019
Dedumo Law Office
2F Revelo Bldg. Purok 6
Brgy. Tayaga, Claver, Surigao Del Norte