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I, CELIE, of legal age, Filipino, and a resident of block 3 lot 6 San Pedro,
Laguna, Philippines, with current address at Commonwealth, Quezon City,
Philippines, and also representing JOHN AND MARIE, 6 and 3 years old
respectively, after having duly sworn to in accordance with law, depose and state

I, CELIE, is the surviving spouse of the deceased PEDRO who died on 02

December 2017 at Amsterdam, Netherlands.

That we, CELIE and my two minor children, JJOHN AND MARIE, are
the only surviving heirs of the late Jason Arenajo Del Mundo. We are the
beneficiaries of the deceased’s life insurance policies under _________for EURO
12,500.00 and _____________ for EURO 45,000.00.

That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for all legal intents and purposes that it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________ at _____________, Philippines.

_____________________ JOHN
CELIE Date of Birth: July 25, 2012
Date of Birth: April 10, 1983 Son of Deceased
Spouse of the Deceased Represented by:


Date of Birth: August 19, 2015
Daughter of Deceased
Represented by:


SUBSCRIBE AND SWORN TO before me this _______________ at

_________________, Philippines and affiant having exhibited to me her
driver’s license no. _______________.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2019