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Affidavit of Insurance Rights Waiver

Edgardo I. Villanueva affirms in an affidavit that his brother Nestor I. Villanueva died on October 12, 2016. Edgardo states that he has waived any rights or claims to Nestor's SSS insurance plan benefits and consents to the transfer of the plan to Nestor. Edgardo also attests that the SSS insurance plan benefits were not used during Nestor's wake.

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Ýel Äcedillo
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165 views1 page

Affidavit of Insurance Rights Waiver

Edgardo I. Villanueva affirms in an affidavit that his brother Nestor I. Villanueva died on October 12, 2016. Edgardo states that he has waived any rights or claims to Nestor's SSS insurance plan benefits and consents to the transfer of the plan to Nestor. Edgardo also attests that the SSS insurance plan benefits were not used during Nestor's wake.

Uploaded by

Ýel Äcedillo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines)

City of Calapan ) S.S.


Province of Oriental Mindoro)

AFFIDAVIT

I, EDGARDO I. VILLANUEVA, 51 years old, Filipino, single and a resident of


Brgy. Pinagsabangan I, Naujan, Oriental Mindoro, after having been duly sworn in
accordance with Law hereby depose and say:

1. That I am the brother of NESTOR I. VILLANUEVA, a plan holder of SSS


Insurance Plan;

2. That my brother died on October 12, 2016 in Pinagsabangan I, Naujan,


Oriental Mindoro;

3. That I have allowed and consented to the transfer of this insurance plan to my
brother NESTOR I. VILLANUEVA;

4. That I have waived my rights, interest and participation for any benefits in
SSS in favor of NESTOR I. VILLANUEVA and I no longer intend to make SSS
liable under the contract;

5. That I am executing this affidavit to attest to the truth of the foregoing as the
benefits under the said Insurance Plan was never availed during the wake of
my brother, NESTOR I. VILLANUEVA;

6. That I avow under penalty of law to the whole truth of the contents of this
affidavit.

IN WITNESS WHEREOF, I HAVE HEREUNTO SET MY HAND, this 9th

day of October, 2017 at Calapan City.

EDGARDO I. VILLANUEVA
(Affiant)
LTO Driver’s License No. X01-09-002515

SUBSCRIBED AND SWORN TO BEFORE ME, this 9th day of October, 2017

at Calapan City.

Doc. No. ____;


Page No. ____;
Book No. ____;
Series of 2017.

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