ACKNOWLEDGMENT

Republic of the Philippines }

City of Dumaguete } S.S.
Province of Negros Oriental }

BEFORE ME this 28th day of January 2019 at Dumaguete City, Negros Oriental,
appeared before me the following with the respective competent proof of
identification:
RAY FERNANDO GUATELARA LTO Driver’s License No. G-02-74-015048
expiring on 2022/07/18
ANGELINA OLIVARES UMID 0003-8696836-1
JESFER C. GUATELARA OSCA ID 10824
known to me and to me known to be the same person who executed the foregoing
AUTHORIZATION FOR CREMATION AND DISPOSITION therein consisting of FOUR (4)
pages including this page where the acknowledgement is written, and acknowledged to
me that the same is their free and voluntary act and deed.
WITNESS MY HAND AND SEAL

Doc. No. _____;

Page No._____;
Book No._____;
Series of 2019.