Republic of the Philippines

Province of Cavite
City of Trece Martires

)
) S.S.
)

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSON

We, YANIELYN ORATA DOMINGO, of legal age, Filipino citizen, with
residence at Blk. 15, Lot. 51, Brazil St. Country Meadow, San. Francisco, Gen. Trias
Cavite and TITA BAUTISTA, of legal age, Filipino citizen, with residence Blk. 15 A,
Lot. 37, Brazil St. Country Meadow, San. Francisco, Gen. Trias Cavite, under oath
states that:
1. That we personally know the late DOMINIC CEZAR PARCON, son of the
spouses Ramon Parcon and Nomina Cezar;
2. That Dominic Cezar Parcon, is a member of the Social Security System and
the Home Development Mutual (PAG-IBIG ) Fund ;
3. That we know for a fact that a discrepancy is attendant as to the actual middle
name of Dominic. In his Certificate of Live Birth, the middle name inscribed,
although blurry can be visibly read as Cezar and the same has been
habitually and continuously used by Dominic in all of his personal and
legal records However , upon verification ( Web Inquiry System ) on his
SSS records the middle name CESAR ( third letter spelled with a S )
appeared in contrast to what had been inscribed on his E-4 Form; wherein
CEZAR ( third letter spelled with a Z);
4. Similarly, the middle name of Dominic was wrongfully spelled on the
following documents, (1) Brgy. Certification for SSS Claim (2) Certificate of
live birth of Jacob A. Parcon (3) Certificate of live birth of John Leo Mark
A. Parcon, (4) Certificate of Death of Dominic Cezar Parcon;
5. We hereby attest that the true and correct middle name of Dominic should
be recorded as CEZAR, proven by his certificate of live birth and other
existing identifications ( i.e certificate of marriage, Pag-Ibig I.d ,etc.), which
are reproduced and attached hereto;
6. That names DOMINIC CEZAR PARCON and DOMINIC CESAR PARCON,
particularly and significantly refers to one and the same person;
7. Likewise, the name of Dominics mother was erroneously inscribed on his
Certificate of Death wherein NONIMA CEAZAR (with an A) was
inscribed as opposed to NOMINA CEZAR appearing on Dominics
certificate of birth. We can also confirm from our own personal knowledge
that full name is to be correctively recorded as NOMINA CEZAR
8. That we are not related to Dominic Cezar Parcon, either by affinity or by
consanguinity nor have any direct interest to the outcome of this affidavit;
9. We are executing this affidavit to attest the truthfulness of the foregoing
declarations under penalties of perjury to correct the discrepancy herein
specified in support of any and all claims due and favorable to the late
Dominic Cezar Parcon at the S.S.S and Home Development Mutual (PAGIBIG ) Fund moreover to serve all other legal intents and transactions.
IN WITNESS WHEREOF, we have hereunto set our hand on this 26th day of June
2013 at Trece Martires City, Cavite.

YANIELYN ORATA DOMINGO

Affiant

TITA BAUTISTA
Affiant

Philhealth I.d 08-050598348-7

SSS Membership I.d

SUBSCRIBED AND SWORN to before me on this 26th day of June 2013 at

Trece Martires City, Cavite. Affiant exhibited to me their competent proof of their
identity above specified.

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2013

ATTY. FE B. AONUEVO
NOTARY PUBLIC Until 31 December 2014
ROLL OF ATTORNEY No. 35746
IBP No. 902501 - 08-15-12 Imus Cavite/ PTR No. 3179872 -01-07-13 TMC Cavite
4TH MCLE Exemption No. 000189
Unit 3 Provincial Capitol Compound Trece Martires City, Cavite