Republic of the Philippines)

City of Dipolog…………….)s.s.

AFFIDAVIT OF AUTHENTICITY

I, FLORIPES J. SALAC, Filipino, of legal age, widow, and a resident of

Poblacion, Sibutad, Zamboanga del Norte, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the legitimate claimant wife of the late NARQUILINO B.

SALAC;

2. That all documents I have submitted hereto to support my claim are

genuine and authentic;

3. That I hold myself liable for perjury, falsehood, misrepresentation or

omission or any act of dishonesty for any fraudulent, false, and
tampered documents that I have submitted;

4. That I agree to the automatic stoppage of processing of my claims for

retirement benefits if any of the attached documents are fake or
fraudulent;

5. That I am fully aware that any misrepresentation is a ground for

prosecution; and

6. That I attest to the truthfulness of this undertaking and I submit to the

legal and administrative consequence thereof if the statements above
are wanting in truth and substance.

FURTHER AFFIANT SAYS NONE:

FLORIPES J. SALAC
Affiant
Contact No.: 09161036981

SUBSCRIBED AND SWORN to before me this ________________

at Dipolog City, Philippines.

Doc No.: _____;

Page No.: _____;
Book No.: _____;
Series of 2018.