Republic of the Philippines)

La Trinidad, Benguet) s.s..

AFFIDAVIT OF KINSHIP
I, Virginia Fianza Gut-omen, of legal age, widow, Filipino and a resident of No. 29 Sum-At,
Caluttit, Bontoc, Mountain, Province, after having been duly sworn to in accordance with law, do
hereby declare and state THAT:

1. I am the wife of the late Noel Depalog Gut-omen, of Bontoc, Mountain Province,
Philippines, my late husband and I got married on January 3, 1997, attached hereto is a
copy of our Certificate of Marriage;

2. I am the nearest surviving kin of Noel Depalog Gut-omen being his widow;

3. My husband died intestate on January 18, 2019, attached hereto is a copy of his Death
Certificate, and has not instituted any administrator nor representative for any
purpose;

4. During the lifetime of my deceased husband, I have never been disowned neither did I
disowned him;

5. Further, I am executing this Affidavit of Kinship to support my request/application with

the Philippine Statistics Authority (PSA) for the issuance of an Advisory on Marriage
(AOM). I hereby undertake to be solely responsible for the contents of my Affidavit in
case of any resulting damage or prejudice and hereby further hold the government or
PSA free therefrom;

6. Finally, I am executing this Affidavit of Kinship to attest to the truthfulness of the

foregoing facts and for all legal intents and purposes this may serve well;

IN WITNESS WHEREOF, I have hereunto set my hand this________________________

at___________________________.

Virginia Fianza Gut-omen

Affiant
Passport ID No. EC74799208

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad, Benguet,
Philippines this______________________ by the above Affiant personally known to me and
exhibiting to me Valid Identification Card (IDs) with picture above his name and personally
identified by me of his identity to be the same person who personally signed before me the foregoing
Affidavit.