REPUBLIC OF THE PHILIPPINES)

Province of Eastern Samar ) S.S.

Municipality of Balangiga
)
x-----------------------x

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

RE: DATE/PLACE OF DEATH
We, MARK WINSTON F. ORTILLO and PANFILO E. BIONG, JR, both
of legal ages, Filipinos, and residents of Barangay 03, Nula-Tula, Tacloban City
and Barangay Sta. Rosa, Balangiga, E. Samar, respectively, after having been
duly sworn to in accordance with law, do hereby depose and state the
following:
That we personally know the late Renato C. Bacang because we were
employees of AQUALINE CONSTRUCTION;
That we also know for a fact that said Renato C. Bacang while doing
his job as a welder of the company in Brgy. Manlurip, San Jose,
Tacloban City, Leyte last March 19, 2016 met an accident;
We likewise have knowledge that said Renato C. Bacang died on that
same day (March 19, 2016) while undergoing treatment for
electrocution at Tacloban Doctors Hospital, Tacloban City, Leyte;
That we are executing this affidavit to attest to the truthfulness of the
fact of death of the person of Renato C. Bacang and for whatever
legal purposes that this statement may serve.
IN WITNESS WHEREOF, we have hereunto set our hands this 21 st day
of June, 2016 at Balangiga, E. Samar, Philippines.
Mark Winston F. Ortillo
AFFIANT
TIN NO. 454-309-299

Panfilo E. Biong, Jr.

AFFIANT
UMID CRN:0111-1619486-7

SUBSCRIBED AND SWORN to before me this 21st day of June, 2016

at Balangiga, E. Samar, Philippines, affiants exhibited to me their proofs of
identity shown above.

Doc. No._____;
Page No._____;
Book No. IV;
Series of 2016.