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Republic of the Philippines )

City of Tagbilaran ) S.S.

JOINT- AFFIDAVIT OF TWO DIS-INTERESTED PERSONS

We, DOMINCIANO LIBATON LOZADA and MICHELLE DUMANAYOS


LOZADA, both married, Filipinos, of legal ages, and residents of Barangay Babag,
Dagohoy, Bohol, respectively, having been duly sworn in accordance with law,
hereby depose and state:

1. We both personally know the person of BELLIZA PERGES as her family had
been close friends to us;

2. That we also know that she used the name BELLIZA PERGES in all her public
and private documents and he is known in the community as BELLIZA
PERGES;

3. That as reflected in her Birth Certificate, her name appears to be BELLIZA


PERGES;

4. That as far as we are concerned, we know her mother to be, ELIZABETH


MASILLONES PERGES and she had an unknown father, therefore, she is
registered as an illegitimate child in her Certificate of Live Birth;

5. That she had been married to REXAN B. PARILLA, and as a result thereof,
she had been using her married name, BELLIZA PERGES PARILLA;

6. That we hereby attest that the names BELLIZA PERGES and BELLIZA M.
PERGES, REFER TO ONE AND THE SAME PERSON who is our close family
friend for a long time now;

7. That we are not related by affinity or consanguinity to the said BELLIZA


PERGES nor are we given reward for executing this affidavit. The same is not
executed to evade any criminal, civil, or administrative liability or to obstruct
justice;

8. That we execute this Affidavit to attest the veracity of the above-statements,


for the purpose of registering her with the Social Security System (SSS) and
that of registering her beneficiaries, from BELLIZA M. PERGES to the name
BELLIZA PERGES and for any other legal purpose that this Affidavit may
serve best.

IN WITNESS WHEREOF, we have hereunto set our hands this ____________


at Tagbilaran City, Bohol, Philippines.

DOMINCIANO LIBATON LOZADA MICHELLE DUMANAYOS LOZADA


Affiant Affiant

SUBSCRIBED AND SWORN TO before me this _________________ss


at Tagbilaran City, Bohol, Philippines. Affiants exhibited to me their Voter’s
Identification Card No. VIN:1217-0007A-L2876DLL10000 issued by COMELEC
Dagohoy, Bohol and Professional Regulation Commission (PRC) No. 0900582 issued
by PRC, Manila, respectively.

DIANE CHRISTI M. GARCIA-CLARABAL


PUBLIC ATTORNEY
(PURSUANT TO R.A. 9406)