Republic of the Philippines )

Done in the _______________ ) s.s.

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, ___________________ and ________________, both of legal age, married,

respectively, Filipino Citizens and both residents of__________________, after having
been duly sworn to in accordance with law do hereby depose and state:

1. We personally know _____________________________, who is our long time

neighbor and acquaintance;

2. That since childhood, our neighbors and friends call her “_______” and since
then, we have been accustomed to calling her by the name, “______”;

3. That the name “_______” and “_______” as appearing in her identification

cards refer to one and the same person;

4. We are not related by affinity or consanguinity to the above mentioned

person nor do we have any pecuniary interest in this matter whatsoever;

5. That we are executing this affidavit to attest to the truth of the above
statements and for the purpose of supporting their Application for Burial
Assistance and Change of Account Name with the ______.

IN WITNESS WHEREOF, we have hereunto set our signatures this 3rd day of
May 2019, in the City of Baguio, Philippines.

____________________________ _________________
Affiant Affiant