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Affidavit: of Claimant

Kenneth P. Monsod files an affidavit to claim benefits from Pioneer Insurance as the beneficiary of his late brother Lester P. Monsod. Kenneth states that Lester died on June 16, 2021 at Taguig Pateros District Hospital, as shown on his death certificate. Lester had been a member of Pioneer Insurance for almost three years. Kenneth executes this affidavit to certify the facts and process the insurance claim.

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1K views1 page

Affidavit: of Claimant

Kenneth P. Monsod files an affidavit to claim benefits from Pioneer Insurance as the beneficiary of his late brother Lester P. Monsod. Kenneth states that Lester died on June 16, 2021 at Taguig Pateros District Hospital, as shown on his death certificate. Lester had been a member of Pioneer Insurance for almost three years. Kenneth executes this affidavit to certify the facts and process the insurance claim.

Uploaded by

Michael Dator
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 )

City of Pasig ) S.S.

AFFIDAVIT OF CLAIMANT

I, KENNETH P. MONSOD, of legal age, Filipino, single and a resident of


121 Bantayan St. Palingon Tipas, Taguig City, after having been duly sworn to in
accordance with law, do hereby depose and state that:

1. I am the Brother of the late LESTER P. MONSOD who died on June 16,
2021 in Taguig Pateros District Hospital. A copy of his Certificate of Death is
herein attached;

2. My deceased Brother, LESTER P. MONSOD, has been member of


PIONEER INSURANCE for almost five (3) years;

3. I execute this affidavit to certify and attest to the truth of the foregoing facts
and to process our claim with the PIONEER ISURANCE as beneficiaries of my
late Brother, LESTER P. MONSOD.

4. This Affidavit is executed for whatever legal purpose/s that it may serve.

IN WITNESS WHEREOF, I have set my hand this ______ at


__________.

KENNETH P. MONSOD
Affiant
Driver’s License: N50-19-004021

SUBSCRIBED AND SWORN to before me, this _______ at City of Pasig,


by the Affiant who is personally known to me (Driver’s License) and who exhibited
his Identification Card as indicated above.

.
NOTARY PUBLIC

Doc. No. ______;


Page No. ______;
Book No.______;
Series of 2021.

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