REPUBLIC OF THE PHILIPPINES)

CITY PASAY ) S.S.

JOIN AFFIDAVIT

That we, RODEL LABANANCIA DOCTOR AND ZOSIMO BANILYA CILOY, both legal age and with postal
address at 09 Manga st., Ipil Sirte BF Hms Pque City and b18lot18 Monica Gatc. Subd., San Dionisio Pque
City, after having been duly sworn to accordance with law, depose and state that:

1. That we personally known CARINA BELDIA BACLAS mother of BOYET BACLAS DICHOSA SR. and
the father of Ms. Chuchie INDAC, name WILFREDO SR. INDAC. Because we are friends and
neighbors.
2. That in the Certificate of marriage contract of Mr. BOYET DICHOSA AND MS. CHUCHIE INDAC the
name of the father of MR DICHOSA is written/type as ANA DICHOSA instead of CARINA BELDIA
BACLAS DICHOSA and the name BOYET BACLAS DICHOSA AND BOYET BACLAS DICHOSA SR. and
the name WILFREDO INDAC and WILFREDO SR. INDAC, are and the same person.
3. That we are requesting your good office for the necessary correction of their name from ANA TO
CARINA AND BOYET BACLAS DICHOSA SR and WILFERDO INDAC TO WILFREDO INDAC SR. as per
evidenced attached the documents attached in the application for the death claim of MR.
BOYET BACLAS DICHOSA SR.
4. That we are executing this affidavit to attest to the truth of the above statement.

FURTHER SAYETH NAUGHT.

RODEL LABANANCIA DOCTOR ZOSIMO BANILYA CILOY

AFFIANT AFFIANT

SSS/PHILHEATH__________ SSS/PHILHEALTH_______________

SUBSCRIBED AND SWORN to before me this November 23, 2017 at Manila City, Philippine.

Doc. No. 233

Page No. 44

Book no. 01

Series of 2017