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Republic of the Philippines) Done: In the City of Baguio) s.s. AFFIDAVIT OF FUNERAL EXPENSES I, VERONICA F.

VELASCO, of legal age, widow, Filipino citizen with residence and postal address at Backong,Loacan, Itogon, Benguet, Philippines, after having been duly sworn to in accordance with law hereby depose and state: 1. That I am the widow of the late RAMON SALVADOR VELASCO who died on March 14, 2013 at Backong, Loacan, Itogon, Benguet; 2. That during the wake and until he was buried at Family Cemetery, Backong, Loacan, Itogon, Benguet, I spent the sum of ONE HUNDRED FIVE THOUSAND PESOS (Php.105, 000 .00) which are hereto breakdown in the following manner: ITEMS a. Funeral expenses b. 6 Cavan of Rice c. 6 Pigs d. Drinks and groceries AMOUNT P18, 000.00 P10, 000.00 P65, 500.00 P 11,000.00

3. That I am executing this affidavit to attest to the veracity and truthfulness of the foregoing and to support my application for Burial Claim at the SSS-Baguio City Branch; 4. Further executing this instrument for all legal intents and purposes it may serve. IN WITNESS WHEREOF, I have hereunto affixed my signature this 2nd day of April, 2013 at Baguio City, Philippines.

VERONICA F. VELASCO Affiant CTC. No.0637607 Issued On: April 1,2013 Issued at: Itogon, Benguet SUBSCRIBED AND SWORN to before me this 2nd day of April, 2013 at Baguio City, Philippines. Affiant personally appeared before me and identified by me through her Community Tax Certificate as indicated below her name and the same person who executed this instrument freely and willingly. Doc. 325; Page No. 66; Book No. 3 Series of 2013.