Republic of the Philippines

City of Tagbilaran

]
] S.S.

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, RONALDO B. RAMIREZ, Filipino, of legal age, married and a resident of
Dagohoy, Bohol, and JULIUS E. ASUCAN, Filipino, of legal age, single and a resident of
Carmen, Bohol after being duly sworn in accordance with law, hereby depose and say:
That we are the friends and thus personally know the person of FELEX B.
LOMOSBOG, the son of Spouses Salomon B. Lomosbog and Heronema S. Sucandan
on September14, 1944 at Tubigon, Bohol;
That FELIX B. LOMOSBOG is a bonafie member of the Philippine Health
Insurance Corporation (PHIC) with PIN: 230039677194;
That FELIX B. LOMOSBOG is the husband of Maria P. Doydoy;
That the following discrepancies appeared in some of his documents, to wit;
FELIX SUCANDAN LUMOSBOG, SR. as per his PhilHealth Benefit Eligibility
Form issued by PhilHealth;
FELIX SUCANDAN LUMOSBOG as per his hospital records with the Ramiro
Community Hospital, Tagbilaran City, Bohol;
FELIX LUMOSBOG as per his Senior Citizen ID No. 1358 issued by OSCADagohoy, Bohol on April 20, 2010;
That by virtue of these presents, we hereby attest that the names, FELIX
SUCANDAN LUMOSBOG, SR. as per his PhilHealth Benefit Eligibility Form issued by
PhilHealth FELIX SUCANDAN LUMOSBOG as per his hospital records with the Ramiro
Community Hospital, Tagbilaran City, Bohol, FELIX LUMOSBOG as per his Senior
Citizen ID No. 1358 issued by OSCA-Dagohoy, Bohol on April 20, 2010 and FELEX
LOMOSBOG as per his Marriage Contract with Maria P. Doydoy issued by the Office of
the Municipal Civil Registrar of Dagohoy, Bohol, all refer to one and the same person,
that is the person of FELEX B. LOMOSBOG, the son of Spouses Salomon B. Lomosbog
and Heronema S. Sucandan on September14, 1944 at Tubigon, Bohol and a bonafie
member of the Philippine Health Insurance Corporation (PHIC) with PIN: 230039677194
and the husband of Maria P. Doydoy;
That we are not in a way related either by consanguinity or affinity to the said
person and neither are we interested in the outcome of this affidavit, our purpose being
merely to set the records straight;
That we are executing this affidavit not for purposes of fraud but to prove the real
name of FELIX B. LOMOSBOG and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, we have hereunto set our hands this ______________
at the City of Tagbilaran, Bohol, Philippines.
RONALDO B. RAMIREZ
Affiant
VIN ID No: No. 1271-0019A-D1878RBR10000
Issued by Commelec Dagohoy

JULIUS E. ASUCAN
Affiant
DL ID No. N03-13-020626
Issued by LTO Tagbilaran

SUBSCRIBED AND SWORN to before me this _______________ at the City of

Tagbilaran, Bohol, Philippines. Affiants exhibited to me their competent proof of identity,
written below their names.
Doc. No. ______;
Page No. _____;

Book No________;
Series Of 2016..