REPUBLIC OF THE PHILIPPINES )

Las Piñas City ) S.S.

AFFIDAVIT OF GUARDIANSHIP

I, DENIA MERCADO ADMANA, Filipino, of legal age, single, and presently residing
at 30 Molave Road, Pilar Village, Las Piñas City, after having been duly sworn in accordance with
law, do hereby depose and say:

1. That I am the BIOLOGICAL MOTHER OF THE FOLLOWING MINOR

CHILDREN: ABIGAEL MAE ADMANA PALLUGNA, 15 years old,
ALYSSA MAE ADMANA PALLUGNA, 12 years old, and ARIANNE MAE
ADMANA PALLUGNA, 11 years old;

2. That the aforementioned children are all acknowledged natural children of

ARCADIO BANGIS PALLUGNA, JR., who died on August 31, 2019 at Las
Piñas City;

3. That the aforementioned natural children are all under my care and custody;

4. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual

drunkard or a habitual criminal, and have not abandoned, neglected or refused
to support said minor/s or caused him/them to commit offenses against the law;

5. That I am executing this affidavit to attest to the truth of all the foregoing
statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of September, 2019
at Las Piñas City, Philippines.

DENIA MERCADO ADMANA

Affiant

SUBSCRIBED AND SWORN to before me this ____ day of September, 2019 at Las Piñas
City, Philippines, affiant exhibiting to me her competent evidence of identity by way of her
PhilHealth ID Card No. 01-026522856-4.

Doc No. : _____ Notary Public

Page No.: ______
Book No.: ______
Series of 2019