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Affidavit of Nearest of Kin

Clotilde L. Tajarros affirms under oath that: 1) She is the only surviving kin of Antonia T. Salvacion, who was married to Alfredo A. Salvacion Jr. and died without children. 2) Antonia T. Salvacion died on August 21, 2019 and was a member of the Philippine Health Insurance Corporation. 3) Clotilde is executing this affidavit to support her application for reimbursement of Antonia's hospital bill from the Philippine Health Insurance Corporation.

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Ana Rose Cinco
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472 views1 page

Affidavit of Nearest of Kin

Clotilde L. Tajarros affirms under oath that: 1) She is the only surviving kin of Antonia T. Salvacion, who was married to Alfredo A. Salvacion Jr. and died without children. 2) Antonia T. Salvacion died on August 21, 2019 and was a member of the Philippine Health Insurance Corporation. 3) Clotilde is executing this affidavit to support her application for reimbursement of Antonia's hospital bill from the Philippine Health Insurance Corporation.

Uploaded by

Ana Rose Cinco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines )

Province of Leyte ) S.S.


Tacloban City )

AFFIDAVIT OF NEXT OF KIN

I, CLOTILDE L. TAJARROS, of legal age, single, and residing at 277


Liberation St., Dagami, Leyte, under oath, do hereby depose and say that:

1. I am the only nearest surviving kin of Antonia T. Salvacion who is married


to Alfredo A. Salvacion Jr.;
2. Antonia T. Salvacion and Alfredo A. Salvacion Jr. both died without any
child;
3. Antonia T. Salvacion who died on August 21, 2019 is a member of
Philippine Health Insurance Corporation with ID No. 13000040430;
4. I am executing this Affidavit to attest to the truth of the foregoing and to
support my application for reimbursement of the Hospital Bill of my sister,
Antonia T. Salvacion, from Philippine Health Insurance Corporation.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________


in Tacloban City, Philippines.
 
 

CLOTILDE L. TAJARROS
Affiant
UMPID Number CRN 0111-7324164-3

 SUBSCRIBED AND SWORN TO before me this____________ in __________,


Philippines, affiant exhibiting to me her competent evidence of identity as herein
stated above.
 
 
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2022.

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