REPUBLIC OF THE PHILIPPINES )

CITY OF KABANKALAN ) SS
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JOINT AFFIDAVIT OF EXPENSES

WE, NEMFA H. AMEN and RONILO T. DESUSA, Filipinos, of legal

ages and respectively residents of Kabankalan City, Negros Occidental, after
having duly sworn to according to law hereby depose and say:

That we personally know the late ARCADIO P. RABADILLA, JR, who

died intestate on January 1, 2015 at Galicia, Ilog, Negros Occidental;

That the deceased was an SSS Member with No. 07-0412034-I;

That his wife JOVITA M. RABADILLA shouldered all the burial

expenses of her husband as follows:

1. Funeral Expenses - Php. 24,050

2. Embalming - 1,200
2. Memorial Service - _1,800

Total Php. 27,050.00

That we are not in any way related to the above-named person either
by affinity or by consanguinity;

That we expressly execute this affidavit to prove the foregoing facts

and for whatever lawful purpose this may serve best.

IN WITNESS WHEREOF, we hereunto set our hands this 16 th day of

January, 2015 at Kabankalan City.

NEMFA H. AMEN RONILO T. DESUSA

Affiant Affiant
CTC No. 17178118 Drivers License
Issued on: 01-16-15 ID No. FO1-03-214189
Issued at: Kabankalan City

SUBSCRIBED AND SWORN to before me this 16th day of January,

2015 at Kabankalan City, Negros Occidental.