REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LA UNION ) Sc.

MUNICIPALITY OF TUBAO )
x-------------------------x

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, ANTONIO VERCELES and HILARIO A. JARAVATA, both of legal ages,
Filipino citizens and residents of Poblacion, Tubao, La Union, after having been duly sworn to in
accordance with law hereby declare and say:

1. That we personally know TOMAS CHUA ZARATE, child of Florencio

Manongdo Zarate and Li Chu Chua and was born on December 29, 1940 at
Tubao, La Union;

2. That we personally know the above-named person and his parents for the reason that
they are our friends and barangay-mates;

3. That said TOMAS CHUA ZARATE was born by “traditional hilot” at their house;
consequently, the facts of birth of said child is not yet duly registered before the
Local Civil Registrar and the Philippine Statistics Authority;

4. As nobody advised them, the parents were not aware that there is a need to register
the birth of their child immediately, so it is only now that the son is applying for the
delayed registration of his birth;

5. That we were informed that the facts of birth of TOMAS CHUA ZARATE , was
not duly registered or cannot be found with the Local Civil Registrar and the
Philippine Statistics Authority as the records of birth were allegedly burned or
destroyed by fire during World War II;

6. That we are not related to the above-named person and his parents either by
consanguinity or affinity;

7. That we are executing this affidavit to support the application of TOMAS CHUA
ZARATE for the registration of the fact of his birth with the office of the Local
Civil Registrar of Tubao, La Union and the Philippine Statistics Authority and to
attest to the truthfulness of the foregoing and for all-legal intents and purposes.

IN WITNESS WHEREOF, we have hereunto set our hands this 16th day of May 2017
at Tubao, La Union, Philippines.

ANTONIO VERCELES HILARIO A. JARAVATA

Affiant Affiant
Senior ID No. 2511128 Senior ID No. 2512310

SUBSCRIBED AND SWORN to before me this 16th day of May 2017 at Tubao, La
Union by the affiants appearing personally and who are known to me to be the same persons
who executed this affidavit.

ATTY. JOONEE RANDYL E. RIVERA

Notary Public until December 31, 2018
Doc. No.: 33; Aspiras Highway, Francia Sur, Tubao, La Union
Page No.: 07; Roll No. 61766, TIN 929-347-628
Book No.: XII; PTR No. 1470534; 01-03-17, Tubao, LU
Series of 2017. IBP Life Member No. 012553; 01-02-14, SFLU
Commission No. ANC-2016-30