Republic of the Philippines ]

City of Tagbilaran ] S.S.

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, MA. FE L. PIANG, Filipino, of legal age, single, and a resident of Tambungan,
Candijay, Bohol, Philippines and FLORDELIZA P. ILANDAG, Filipino, of legal age, single,
and a resident of Tawid, Candijay, Bohol, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That we know one GIAN DEE D. TANGUB and one GEE DEAN D. TANGUB;

2. That we know them to be the sons of GINALYN JUSTOL DELIMAN and

DIOSCORO BUCTUAN TANGUB;

3. That both GIAN DEE D. TANGUB and GEE DEAN D. TANGUB were admitted at
Governor Celestino Gallares Memorial Hospital;

4. That Gian Dee D. Tangub was admitted and confined thereat for the period August
18-20, 2018;

5. That Gee Dean D. Tangub was admitted and confined thereat for the period August
15-17,2018

6. That the attachments on their respective billings for the abovementioned

confinements were erroneously interchanged. The attachment intended for the billing
statement of Gian Dee D. Tangub’s confinement was erroneously attached to the
billing statement intended for Gee Dean D. Tangub; while the attachment intended
for the billing statement of Gee Dean D. Tangub’s confinement was erroneously
attached to the billing statement intended for Gian Dee D. Tangub;

7. That the error was due to inadvertence and was done without malice as the said
attachments were prepared simultaneously;

8. We are executing this Joint Affidavit to attest to the truth of the foregoing facts and
to support their PhilHealth claim and in compliance with the requirements of
Philhealth;

9. That affiants further attest to the truth of the foregoing statements for whatever legal
purpose this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this 31st day of January
2019 at the City of Tagbilaran, Bohol, Philippines.

MA. FE L. PIANG FLORDELIZA P. ILANDAG

Affiant Affiant

SUBSCRIBED AND SWORN to before me this 31st day of January 2019 at the City of
Tagbilaran, Bohol, Philippines. Affiants are personally known to the undersigned.

ATTY. JANICE MENDEZ PARILLA

PUBLIC ATTORNEY
(PURSUANT TO R.A. 9406)