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Affidavit of Income Declaration

The affidavit declares that the affiant is a member of PhilHealth with a specific PIN number. It states that the affiant earns a monthly income of around P4,000 as a laborer. The affiant affirms that the statements in the affidavit are made in good faith to attest to the truth regarding PhilHealth premium payments and for any legal purposes.

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100% found this document useful (1 vote)

18K views1 page

Affidavit of Income Declaration

The affidavit declares that the affiant is a member of PhilHealth with a specific PIN number. It states that the affiant earns a monthly income of around P4,000 as a laborer. The affiant affirms that the statements in the affidavit are made in good faith to attest to the truth regarding PhilHealth premium payments and for any legal purposes.

Uploaded by

Copyright

© © All Rights Reserved

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as DOCX, PDF, TXT or read online on Scribd

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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ________) S.c

MUNICIPALITY OF ___________)

AFFIDAVIT OF INCOME DECLARATION

I, ________________, 34 years of age, Filipino, single and a
resident of Brgy. _________________ after having been duly sworn
to in accordance with law do hereby depose and state:

1. That I am a bona fide member of Philippine Insurance

Corporation (PhilHealth) with PIN: _____________;

2. That I am a laborer and is earning a monthly income of more

or less FOUR THOUSAND PESOS (P4,000.00);

3. That I am executing this affidavit in good faith to attest

the truthfulness of the foregoing statements to support my
premium payments at PhilHealth and for whatever legal
purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

3rd day of February 2020 at Wao, Lanao del Sur, Philippines.

________________
Affiant

SUBSCRIBED AND SWORN TO before me this 3rd day of February

2020 at Wao, Lanao del Sur. Affiant having exhibited to me his
Voter’s ID with VIN: _________________________ .

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