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Affidavit of Claim

The affidavit details a widow applying for death benefits after her husband died of acute myocardial infarction. It provides her name, address, the deceased's name and date of death. A copy of their marriage certificate is attached to support her claim.

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Warda Santiago
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32 views1 page

Affidavit of Claim

The affidavit details a widow applying for death benefits after her husband died of acute myocardial infarction. It provides her name, address, the deceased's name and date of death. A copy of their marriage certificate is attached to support her claim.

Uploaded by

Warda Santiago
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF MAGUINDANAO)S.S
CITY OF COTABATO)

AFFIDAVIT OF CLAIM

I, NORHATA BIANG NASA, Filipino, of legal age, widow and presently


residing at PUROK URBAN POOR, NAYON SHARIFF KABUNSUAN, ROSARY
HEIGHTS III COTABATO CITY, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am the widow of LOU LONTO BIANG who died on October 7, 2023
in Cotabato City because of Acute myocardial infarction;

2. That I am the surviving spouse of the deceased;

3. As evidence of our legal relation to the deceased, photocopy of our


Certificate of Marriage is herein attached;

4. That I am executing this affidavit in support of my application for the


death benefit claim with Cotabato Regional Medical Center, to attest to the
truth of the foregoing, and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th day


of March 2024 at Cotabato City, Philippines.

NORHATA BIANG NASA


Affiant

SUBSCRIBED AND SWORN to before me this 11th day of March 2024


in the City of Cotabato, Philippines, affiant exhibiting to me her competent
evidence of identity by way of PHILIPPINE NATIONAL ID NO.
5120-9608-2584-7163 issued at Cotabato City, Philippines on July 9, 2023.

Doc No. : _____


Page No.: ______
Book No.: ______
Series of 2024

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