REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

MUNICIPALITY OF CAMILING )

JOINT AFFIDAVIT
OF TWO DISINTERESTED PERSONS

We, MARIO V. DOMINGO and LEONARDO S. MARTIN, of legal

ages, Filipino citizens, and residents of Barangay Bobon 2 nd, Camiling,
Tarlac, after having been duly sworn to in accordance with law, do hereby
depose and state THAT:

1. We both personally know JANE SAMORTIN MARTIN

(Jane, for brevity), who was born on September 14, 1946 to
Spouses Gervacio Martin and Arsenia Samortin;

2. Jane is also known as MRS. JANE MARTIN BLANCO,

after she got married to Tirso Artates Blanco;

3. Tirso, the husband of Jane, is a member of the Social

Security System of the Philippines (SSS) until his death on March 7,
2017;

4. When, Jimmy M. Blanco, the son of Tirso and Jane, went

to the SSS Camiling, Tarlac to file for the Funeral Claim Benefit of
his late father, he was required to submit, among others, copies of
Tirsos Certificate of Death and Identification Cards of his mother
Jane. He was also required to submit a copy of his Certificate of Live
Birth;

5. After submitting the required documents and the SSS ID

Card and Senior Citizen ID Card of Jane to the SSS, Camiling, Tarlac
and upon processing, it was discovered that the recorded name of
Jane appearing in the said Certificate of Live Birth of his son is
JEAN S. MARTIN, instead of JANE S. MARTIN. Hence, the
discrepancy;

6. We are not related to Jane by affinity or consanguinity,

except that of being her barangay mates;

7. We are executing this Affidavit to attest to the fact that

the names JEAN S. MARTIN, as recorded in the above-mentioned
Certificate of Live Birth of Jimmy Martin Balnco, JANE SAMORTIN
MARTIN, and JANE MARTIN BLANCO or JANE M. BLANCO, as
recorded in her SSS ID Card and Senior Citizen ID Card, refer to
one and the same person, and that is the wife of Tirso Artates
 Blanco, the biological mother of Jimmy Martin Blanco, our barangay
mate;

8. Finally, we are executing this Affidavit to attest to the

truth of the foregoing statements and for all legal intents and
purposes it may serve.

IN WITNESS WHEREOF, we have hereunto affixed our signatures

this 17th day of March, 2017 at Camiling, Tarlac, Philippines.

MARIO V. DOMINGO LEONARDO S. MARTIN

Affiant Affiant
Senior Citizen ID Card Senior Citizen ID Card
Control No.: 0699 Control No.: 5705
OSCA, Camiling, Tarlac OSCA, Camiling, Tarlac

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiants exhibited before me their respective competent
evidence of identity indicated below their names.

Doc. No.:_______;
Page No.:_______;
Book No.:_______;
Series of 2017.