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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LEYTE ) S.S.


MUNICIPALITY OF VILLABA )
x--------------------------------------------x

AFFIDAVIT OF GUARDIANSHIP
I, MILDRID YBAEZ, of legal age, Filipino and a resident of Brgy. Libagong, Villaba,
Leyte, Philippines, after being duly sworn to, in accordance with law, do hereby depose and say:

1. That I am the mother of Ralph G. Ybaez and Michaela Joy Ybaez, all minors, who has an
interest in the proceeds of the death benefit on the life of my deceased husband, Roy Dichos
Ybaez, who is member of Barangay Council as Barangay Councilor at Barangay
Libagong, Villaba, Leyte, as well as any other benefits of the said deceased with other
government agencies or instrumentalities and private entities;

2. That I am the mother and guardian of the above-named minors and are under my care and
custody;

4. That I am competent to process on behalf of said minors the proceeds of death benefit on the
life of my deceased husband Roy Dichos Ybaez, who was a member of Barangay Council
as Barangay Councilor at Barangay Libagong, Villaba, Leyte, and the other benefit of the
said deceased;

5. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual drunkard or a


habitual criminal, and have not abandoned, neglected or refused to support said minor or
caused her to commit offenses against the law.

Done this September 8, 2017 at Villaba, Leyte.

MILDRID YBAEZ
Affiant
Voters ID No. 3751-0073A-H2974MGY20000
Issued at: COMELEC Villaba, Leyte

CORROBORATION

We, Mary Joy Delan Velez and Rebecca Delan Velez, both of legal age, Filipino and
both residents of Libagong Villaba, Leyte, respectively, and friends and neighbors, hereby
confirm the foregoing statements of MILDRID YBAEZ, to be true and correct.

_______________________ _________________________
MARY JOY DELAN VELEZ REBECCA DELAN VELEZ
Voters ID No.: 3751-0075A- Voters ID No.: 3751-0075A-
J2781MDV20000 G1673RDV20000
Issued at: COMELEC Villaba, Leyte Issued at: COMELEC Villaba, Leyte

SUBSCRIBED AND SWORN to before me this September 8, 2017 at Villaba, Leyte.


Affiants exhibited to me their respective Identification Cards as indicated above.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of _____.

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