REPUBLIC OF THE PHILIPPINES...

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Done: City of Baguio………………….) S.S.

AFFIDAVIT OF TWO DIS-INTERESTED PERSONS

We, JAMILLE D. FABIA, of legal age, married, Filipino Citizen, with residence and postal
address at T. Alonzo, Baguio City, and LANIE S. COROÑA, of legal age, married, Filipino
Citizen, with residence and postal address at #131 Sunnyside, Fairview, Baguio City, Philippines
after having been duly sworn to in accordance with law hereby depose and state, that:

1. We personally know EDNA M. SALAYSAY and now EDNA SALAYSAY CACHO

who was born on SEPTEMBER 29, 1967 at Bugallon, Pangasinan;

2. Ms. Edna Cacho is an enrolled member of the Philippine Health Insurance Corporation or
PhilHealth with PhilHealth Number 04-025165753-1;

3. Recently, she discovered that her Date of Birth appearing in her PhilHealth ID Card is
NOVEMBER 14, 1967, which is not her correct date of birth;

4. EDNA SALAYSAY CACHO was born on SEPTEMBER 29, 1967 at Bugallon,

Pangasinan and since her younger days it is the same date of birth she used and been
using up to now specifically in all her official transactions. Maybe during the
enrollment/registration with PhilHealth, NOVEMBER 14, 1967 was erroneously entered
as her date of birth instead of SEPTEMBER 29, 1967 by Edna herself or by the
personnel of PhilHealth;

5. With the foregoing circumstances, the person named EDNA SALAYSAY CACHO with
date of birth NOVEMBER 14, 1967 and EDNA SALAYSAY CACHO with date of
birth SEPTEMBER 29, 1967, pertains to one and the same person;

6. We are not in any way related to the above-mentioned person neither by consanguinity
nor affinity. We know the above facts and circumstances as we are long time friends of
the aforementioned person;

7. We are executing this affidavit to attest to the truth of our foregoing statements and for all
legal intents and purposes it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this 21st day of March, 2023 at
Baguio City, Philippines.

JAMILLE D. FABIA LANIE S. COROÑA

Affiant Affiant
PhilHealth ID No. 04-025179206-4 BIR TIN No. 457-620-081
Issued On: 9-12-2014
SUBSCRIBED AND SWORN to before me this 21st day of March, 2023 at Baguio City,
Philippines. Affiants identified by me through their competent evidence of identities.

Doc. No. 181;

Page No. 37;
Book No. 64;
Series of 2023.