AFFIDAVIT

ONE AND THE SAME PERSON

I, ________________, of legal age, Filipino, married to

____________________and with postal address at
______________________________________ San Juan, Metro Manila, hereby solemnly
affirm and declare an oath that:

1. I am the wife of__________________, deponent herein and a Citizen of the

Philippines.

2. I am Widow and my husband died on ____________ at San Juan City.

3. Therefore, the following names refer to the one and the same person:

______________________ (Name in the Certificate of Death);

______________________ (Name under the Transfer Certificate Of Title No.

123456789 of the Register of Deeds for Quezon City;

So I do hereby solemnly affirm that foregoing are true and correct

statements.

_______________________
Deponent

Signed in the presence of:

___________________________________ ____________________________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

City of ____________________ ) S.S.

Personally came and appeared before me at the City of __________________,

Philippines, this____ day of__________________, the following persons with
their respective valid proof identity:

Name Government Number

Known to me and to me known to be the same persons who executed the foregoing
instrument and acknowledged to me that the same is their free act and deed.

This instrument whereon the acknowledgment is written, has been signed by the
party and witnesses on each and every page thereof.

WITNESS MY HAND AND SEAL, at the place and on the date first above
written.

NOTARY PUBLIC

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