Republic of the Philippines)

Province of Southern Leyte…) S.S

City of Maasin)

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, LEONARDO L. ALICO, JR., of legal age, Filipino, single, a resident of Purok 5, Malapoc Norte,
Maasin City, Southern Leyte and DESSAN A. ASIS, likewise of legal age, Filipino, single and a resident
of Basak, Rizal, Maasin City, Southern Leyte, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state;

1. That we personally know the person of ELLANIE LAGUSAD;

2. That she was born on May 23, 1997;

3. That she is the daughter of the Lelane C. Lagusad;

4. That in her Certificate of Live Birth issued by the Philippine Statistics Authority, the entry thereof
appears to be Ellanie Lagusad, as indicated in the marginal annotation of the said document;

5. That however, she erroneously indicated the name Ellanie Caalim Lagusad, upon filing of her
application for SSS Membership;

6. That the name ELLANIE LAGUSAD per Certificate of Live Birth, and the name ELLANIE CAALIM
LAGUSAD as reflected in her SSS membership record, refer only to one and the same person;

7. That we know the fact of the above-named person because we have been friends for quite
some time now;
8. That we are not related to them within the fourth civil degree, either by affinity or
consanguinity;
9. That we are executing this affidavit to attest to the veracity of the foregoing facts and for any
legal purpose this may serve thereby.

IN WITNESS WHEREOF, we have hereunto affixed our signatures this ______________ at Maasin
City, Southern Leyte, Philippines.

DESSAN A. ASIS LEONARDO L. ALICO, JR.

TIN 483-303-341 PRC ID No. 1084737
AFFIANT AFFIANT

SUBSCRIBED AND SWORN TO before me this ____________ at Maasin City, Southern Leyte,
Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2018