REPUBLIC OF THE PHILIPPINES )
___________________________ ) S.S.
AFFIDAVIT OF GUARDIANSHIP
I, JENEVEY ALJANOSO ALCOBER, of legal age, Filipino, single and with residence
and postal address at Inasuyan, Kawayan, Biliran, after being duly sworn to in
accordance with law, depose and state that:
1. I am the mother (relationship) of the minor Zyn Jacob Alcober Pazon who
has an interest in the OWWA Benefits Claim of the late Fred Cyrill Pazon
died last January 12, 2022;
2. I am the legal guardian of the above-named minor;
3. The said minor/s is/are under my care and custody;
4. I am competent to receive in behalf of the said minor/s any amount/s due him;
5. I have not been diagnosed nor committed to a hospital or institution for
imbecile, insane, a vagrant or vicious person. I am not a habitual drunkard or
a habitual criminal, and have not abandoned, neglected or refused to support
said minor or caused him to commit offenses against the law; and
6. This affidavit is voluntarily executed in order to attest to the truthfulness of the
foregoing narration of facts and undertaking for whatever legal purpose it may
serve.
IN WITNESS WHEREOF, I am affixing my signature this _______ day of
_____________________ 2022 in ___________________________________.
______________________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME, this _______ day of
____________ 2022 at ____________________________ Philippines. Affiant exhibited
to me his/her valid government issued Identification (ID) with number ______________
and issued on _____________________ at _________________________________.
Doc. No. __________;
Page No.__________;
Book No.__________;
Series of __________.
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