Republic of the Philippines)

Marikina City )SS.

x-----------------------------------x

AFFIDAVIT
(Attesting Separation from Legal Spouse)

I, Eric Krister N. Songcuan, Filipino, of legal age, married but separated de facto, and a
resident of 357 E. Dela Paz Street, Sto. Nino, Marikina City, under oath depose and state:

1. That I have been separated from my wife, Christine M. Songcuan, since 2016.

2. That though there is no judicial process of annulment or legal separation, my

estranged wife has not been living with me for 7 years now and neither has she been
dependent upon me for support since our 3 kids are living with me since the
separation. She is also aware of my new partner and our 3-year-old son.

3. That I am executing this affidavit to attest the truth of the foregoing facts, in order to
inform Medicard, that my estranged wife, Christine M. Songcuan, is not my
dependent and beneficiary, that I can have my 3-year-old son with my current partner
as my health card provider beneficiary, and for whatever legal intent and purpose this
may serve.

IN WITNESS WHEREOF, I have here unto set my hand this 15th day of November 2023,
at Marikina City, Philippines.

Eric Krister N. Songcuan

Affiant