Republic of the Philippines )

Quezon City, Metro Manila ) SS.

AFFIDAVIT OF CIRCUMSTANCES

I, GENEVIEVE ROSALES NG, of legal age, Filipino, married, and

residing at Block 2 Lot 25 Santan St., Maligaya Park, Brgy. Pasong Putik,
Novaliches, Quezon City, after having been duly sworn to in accordance with law,
do hereby depose and say:

1. That I am the daughter of my deceased mother named AURORA

ROSALES NICDAO, female, 85 years old, died on January 15,
2023 to her third husband;

2. That my deceased mother had a first husband named JOSE YAP

NICDAO, also deceased;

3. That they had only one child named MA. CORAZON NICDAO and
currently residing in DAVAO CITY;

4. That I will claim burial benefits in Office of the Senior Citizens

Affairs (OSCA);

5. That I executed this affidavit to attest to the truth and veracity of the
foregoing facts and not for fraud, and for whatever legal purpose it
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of

January 2023 at Quezon City, Metro Manila, Philippines.

GENEVIEVE ROSALES NG
I.D. No. ___________
Issued on ___________
Issued at ____________

SUBSCRIBED AND SWORN to before me on the date and place above

indicated, affiant exhibiting to me her Identification Card as indicated above.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2023.