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Joint Affidavit for Death Certificate Correction

Two disinterested persons, Arsenia D. Ayaso and Rosalie B. Bangas, executed a joint affidavit to attest that they personally knew Felix Suñir Carlobos, Jr. who was born on May 23, 1955 and died on May 20, 2010. They state that his death certificate incorrectly listed his name without "Jr.", unlike his other identification documents. They confirm that Felix Suñir Carlobos in the death certificate refers to the same person as Felix Suñir Carlobos, Jr., who was the brother of Susana Carlobos Azores applying for an SSS funeral claim. They are not related to the late Felix S. Carlobos, Jr. and

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Denni Dominic Martinez Lepon
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49 views2 pages

Joint Affidavit for Death Certificate Correction

Two disinterested persons, Arsenia D. Ayaso and Rosalie B. Bangas, executed a joint affidavit to attest that they personally knew Felix Suñir Carlobos, Jr. who was born on May 23, 1955 and died on May 20, 2010. They state that his death certificate incorrectly listed his name without "Jr.", unlike his other identification documents. They confirm that Felix Suñir Carlobos in the death certificate refers to the same person as Felix Suñir Carlobos, Jr., who was the brother of Susana Carlobos Azores applying for an SSS funeral claim. They are not related to the late Felix S. Carlobos, Jr. and

Uploaded by

Denni Dominic Martinez Lepon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd

Republic of the Philippines

City of Tacloban

)
) S.S.

JOINT AFFIDAVIT OF TWO (2) DISINTERESTED


PERSONS

We, ARSENIA D. AYASO and ROSALIE B. BANGAS, both of


legal age, Filipinos and residing at V&G Subd., Tacloban City, after
being first sworn according to law, hereby depose and state: THAT--1. We personally know the late FELIX SUIR CARLOBOS, JR.,
who was born on May 23, 1955 and died on May 20, 2010; we were his
close friends and neighbors during his lifetime;
2. However, we were informed that his name was recorded in the
Death Certificate issued by the local civil registry as FELIX SUIR
CARLOBOS (Note: without JR.), unlike his other competent
identification documents, such as his Birth Certificate, SSS records, and
the like, where his full name was faithfully recorded as FELIX SUIR
CARLOBOS, JR.;
3. The name FELIX SUIR CARLOBOS appearing in the death
certificate is actually referring to one and the same person as FELIX
SUIR CARLOBOS, JR., the late brother of Susana Carlobos Azores,
who is the claimant for the SSS funeral claim;
4. We are not related by affinity or consanguinity with the late
Felix S. Carlobos, Jr..
5. We are executing this joint affidavit to attest to the truth of the
foregoing facts for whatever legal purpose this may serve.
IN WITNESS WHEREOF, we have hereunto set our hands this 5
July 2010 at Tacloban City, Philippines.
ARSENIA D. AYASO

ROSALIE

B.

BANGAS
Affiant

Affiant

SUBSCRIBED AND SWORN to before me this 5 July 2010 in Tacloban


City by ARSENIA D. AYASO & ROSALIE B. BANGAS, who have satisfactorily
proven their identity to me through their CTC No. 09894166 issued on
6/23/10 in Tacloban City and CTC No. 09865342 issued on 1/27/10 in Tacloban
City respectively, that they are the same persons who personally signed
before me the foregoing joint affidavit and acknowledged that they executed
the same.
Doc. No. ____
Page No. ____
Book No. 58

SERIES OF 2010

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