1. That I am the father of my daughter _______ by my deceased wife, ______, who died on June 12, 2001;

      2. That by reason of the death of my above-named wife, I henceforth become the father and guardian of my said daughter as she is still a minor having been born on March 13, 1995;

      3. That I am executing this affidavit in order to attest to the truth of the foregoing circumstances and for the purpose of securing an educational insurance for my said daughter in my capacity as her guardian.

      IN WITNESS WHEREOF, I have hereunto set my hand this ____day of May, 2002 at the Municipality of Obando, Bulacan.