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Republic of the Philippines ) Tacloban City ) S.S.

AFFIDAVIT OF GUARDIANSHIP

I, SAKURA LEE of legal age, single, Filipino and a resident of _________ after having been duly sworn to in accordance with law, depose and say:

1. That I am the common law wife of the late JUAN DE LA CRUZ, a member of the 52nd Infantry Battalion (CAFGU);

2. That we started living together purporting ourselves as Husband and

Wife, in Cantaba Sta. Rita Samar on March 16, 2013;

3. That during the subsistence of our relationship, we have conceived and bore a son out of wedlock, JUANITO DE LA CRUZ who was born on FEBRUARY 21, 2015;

4. That last June 26,2015, JUANITO DE LA CRUZ died of cardiac arrest at our residence in Sta. Rita, Samar;

5. That our child, JUANITO DE LA CRUZ is under my care and custody;

6. That I am competent to receive in behalf of the said minor any amount due him; and

7. 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;

8. 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 4th day of December 2015 at Tacloban City, Philippines. SAKURA LEE

Affiant

SUBSCRIBED AND SWORN TO, before me a Notary Public, this day __________________, in the City of Tacloban, Leyte, Philippines.

Doc. No.: Page No.: Book No.: Series of 2015