REPUBLIC OF THE PHILIPPINES)
PARANAQUE CITY )S.S
JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS OF DATE OF BIRTH
We, ARLYN ALJAS LANGUIDO and JOHN CARL D. GUILLERMO, both of legal age, Filipinos, and
resident of 2 Talisay Severina 18, Marcelo Green Village, Paranaque City and 165B Severina 18, Marcelo
Green Village, Paranaque City, after having been sworn to in accordance with law, hereby depose and say
that;
1. That we personally known, the late, BONIFACIA ABRASALDO, who is our long-time neighborhood in
Paranaque City;
2. That the said birthdate of the late, BONIFACIA ABRASALDO, was also appearing in the Certificate of
Live Birth of her son, NICOLAS ABRASALDO PATENIO, registered at Local Civil Registry of Bais City,
Negros Oriental;
3. However, in the SSS record of the late, BONIFACIA ABRASALDO, her birthname was erroneously
recorded as PASING PATENIO, that the said discrepancy was made due to wrong entry of her
birthname;
4. That when the late, BONIFACIA ABRASALDO was registering at SSS, she was erroneously put her
nickname, PASING PATENIO instead of her real birthname;
5. That we hereby certify and affirm that the birthdate of the late, BONIFACIA ABRASALDO, as
appearing in in the Certificate of Live Birth of her son, NICOLAS ABRASALDO PATENIO and the
birthname PASING PATENIO, that is appearing in her SSS record is referring to one and the same
person and BONIFACIA ABRASALDO was her true and accurate birthdate;
6. That we are executing this affidavit to attest to the truth of the foregoing facts and whatsoever this may
serve
IN WITNESS WHEREOF, I have hereunto set my hand this this _____ day __________________ in
Paranaque City
ARLYN ALJAS LANGUIDO JOHN CARL D. GUILLERMO
Affiant Affiant
PhilHealth – 01-200237457-7 National ID – 6021-9074-5812-7820
SUBSCRIBED AND SWORN to before me, in the City of Paranaque, this ____ day of
________________.
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REPUBLIC OF THE PHILIPPINES)
PARANAQUE CITY )S.S
JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS
(re: the same and the one person)
We, _______________________ and ____________________, both of legal age, Filipinos, and
resident of _______________________________________________ and
_______________________________________________________, after having been sworn to in
accordance with law, hereby depose and say that;
1. That we personally known, the EVANGELINA PALATINO VILLAESCUSA, who is our long-time
neighborhood in Paranaque City;
2. That the said birthname of EVANGELINA PALATINO VILLAESCUSA, was also appearing in her
UMID no. CRN-0111-4905222-2;
3. However, in the Merchandise Contract and Statement of Goods and Services issued by Simple
Traditions Cremation and Burial Services located at 165 North Market Blvd., Suite S-208, Sacramento,
California, her name was erroneously recorded as EVA VILLAESCUSA, that the said discrepancy was
made due to wrong entry of her birth name;
4. That we hereby certify and affirm that the birthname of EVANGELINA PALATINO VILLAESCUSA as
appearing in her UMID no. CRN-0111-4905222-2, and the birth name, EVA VILLAESCUSA that is
appearing in the Merchandise Contract and Statement of Goods and Services issued by Simple
Traditions Cremation and Burial Services is referring to one and the same person and EVANGELINA
PALATINO VILLAESCUSA was her true and accurate birthname;
5. That we are executing this affidavit to attest to the truth of the foregoing facts and whatsoever this may
serve
IN WITNESS WHEREOF, I have hereunto set my hand this this _____ day __________________ in
Paranaque City
Affiant Affiant
___________________________ ________________________________
SUBSCRIBED AND SWORN to before me, in the City of Paranaque, this ____ day of
________________.
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Page No.:
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