REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BULACAN ) S.S.

CITY OF MALOLOS

AFFIDAVIT OF SEPARATION

I, VICTORIA F. JOSE, of legal age, Filipino, and presently residing at Blk 17 Lot
2, Regatta North Subdivision, City of Malolos, Bulacan, after having been duly sworn to
in accordance with law, do hereby depose and say that:

1. I am requesting the Sto. Rosario Credit and Development Cooperative to grant

me a loan assistance as it is essential in the business I am putting up;

2. As such I was required to furnish them a copy of different documents, one of

which is an Affidavit of Separation;

3. I have been married to a certain Fernando G. Jose;

4. I hereby certify that I have been separated and estranged with her for 15 years;

5. The social service assistance shall be used solely for the said circumstance;

6. This affidavit is executed to attest to the truth of the foregoing and for all legal
intents this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of June 2019
in the City of Malolos, Bulacan, Philippines.

VICTORIA F. JOSE
Affiant

SUBSCRIBED AND SWORN to before me on the place and date above stated.
Affiant exhibited to me her OSCA ID with no. 359448.

Doc. No. 38; ATTY. JOEL B. ARELLANO

Page No. 8; Commission No. PNC 24-MB-2018
Book No. 48: Notary Public for the Province of Bulacan
Series of 2019. Until December 31, 2019
Provincial Capitol Malolos City Bulacan
PTR NO. 0005584/01-04-2018 MALOLOS
IBP NO. 028077-01-17-2018 BULACAN
ROLL NO. 53884
MCLE COMPLIANCE NO. V-0010161

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BULACAN ) S.S.
CITY OF MALOLOS

AFFIDAVIT OF SEPARATION FROM EMPLOYMENT

I, MARIO C. BALLESTEROS, of legal age, Filipino, and presently residing at

0235 Tabing-Ilog, Bulihan, City of Malolos, Bulacan, after having been duly sworn to in
accordance with law, do hereby depose and say that:

1. I am requesting the Philippine Heart Center to grant me a social service

assistance as it is essential that I watch over my health;

2. As such I was required to furnish them a copy of different documents, one of

which is an Affidavit of Separation;

3. I have been working as a laborer in various welding businesses;

4. I certify that now that I have stopped any gainful employment and/or businesses
and can be declared as separated from employment;

5. The social service assistance shall be used solely for the said circumstance;

6. This affidavit is executed to attest to the truth of the foregoing and for all legal
intents this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of May 2019
in the City of Malolos, Bulacan, Philippines.

MARIO C. BALLESTEROS
Affiant

SUBSCRIBED AND SWORN to before me on the place and date above stated.
Affiant exhibited to me his OSCA ID with no. 28779

Doc. No. 16; ATTY. JOEL B. ARELLANO

Page No. 5; Commission No. PNC 24-MB-2018
Book No. 47: Notary Public for the Province of Bulacan
Series of 2019. Until December 31, 2019
Provincial Capitol Malolos City Bulacan
PTR NO. 0005584/01-04-2018 MALOLOS
IBP NO. 028077-01-17-2018 BULACAN
ROLL NO. 53884
MCLE COMPLIANCE NO. V-0010161