REPUBLIC OF THE PHILIPPINES)

S.S
DONE _______________________________)
********************

AFFIDAVIT OF PROOF OF LIFE

I, EDNA, of legal age, Filipino citizen, widow and a resident of

___________________________, Philippines, after having been duly sworn
to in accordance with law, hereby depose and say that:

1. I am the spouse of the late DANTE who died on

___________________ at __________________;

2. As his surviving spouse, I am well and living together with our

son PEDRO at the above-stated address;

3. I hereby declare and confirm that I and my son are alive;

4. I am executing this Affidavit to attest to the truth of all the

foregoing facts and circumstances and for all legal intents and
purposes that it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

________________________ at _______________, Philippines.

EDNA
Affiant

SUBSCRIBED AND SWORN to before me this

__________________ at ______________________, Philippines. I hereby
certify that I have examined the affiant and that she understood the contents
the same.

NOTARY PUBLIC