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Affidavit of Loss

Ma. Tala N. Acampado swears in an affidavit that she is the mother and legal guardian of Juan Paolo A. Obligacion, a minor. She states that Juan Paolo is the beneficiary of the deceased Pelito B. Obligacion's savings accounts and retirement benefits. Ma. Tala also asserts that she is competent to receive the proceeds on Juan Paolo's behalf and that she has properly cared for the minor. She signs the affidavit to attest to the truth of these statements.

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430 views1 page

Affidavit of Loss

Ma. Tala N. Acampado swears in an affidavit that she is the mother and legal guardian of Juan Paolo A. Obligacion, a minor. She states that Juan Paolo is the beneficiary of the deceased Pelito B. Obligacion's savings accounts and retirement benefits. Ma. Tala also asserts that she is competent to receive the proceeds on Juan Paolo's behalf and that she has properly cared for the minor. She signs the affidavit to attest to the truth of these statements.

Uploaded by

Ann SC
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 SAN FERNANDO )


PROVINCE OF PAMPANGA ) S.S.
x------------------------------------x
AFFIDAVIT OF GUARDIANSHIP
I, MA. TALA N. ACAMPADO, of legal age, single, Filipino citizen, and residing at Zone 6,
Sto. Nino, Abella, Naga City, after being duly sworn to, in accordance with law, do hereby depose
and say:

1. That I am the mother of Juan Paolo A. Obligacion, a minor, who is the beneficiary of
the proceeds of the PSSLAI Passbook and AFPSLAI Passbook of the late Pelito B.
Obligacion, my deceased common law spouse, as well as the GSIS/SSS Fund and
Pag-Ibig Fund benefits of the said deceased;
2. That as evidence, I attached herewith a photocopy of the Birth Certificate of Juan
Paolo Obligacion and an Affidavit Of Paternity marked as Annex “A” and Annex “B.”
3. That I am the guardian of the above-named minor;
4. That the said minor is under my care and custody;
5. That I am competent to receive on behalf of the said minor the proceeds of PSSLAI
Passbook and AFPSLAI Passbook of the deceased, as well as the latter’s benefits
under the GSIS/SSS Fund and Pag-Ibig Fund and any amount due him;
6. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual drunkard
or a habitual criminal, and have not abandoned, neglected or refused to support said
minor or caused her to commit offenses against the law.
7. That I execute this affidavit to attest the truth of the foregoing statements.

Done this _____ day of _______________________ at _______________________.

MA. TALA N. ACAMPADO


AFFIANT

SUBCRIBED AND SWORN to before me this _____day of _______________________ at


_______________________. Affiants exhibited to me their respective Identification Cards as follows:

Name of Affiant ID No Issued at


Ma. Tala N. Acampado Voter’s ID No.: 1724-0046A- Naga City, Camarines Sur
K0676MNA20000

Juan Paolo A. Obligacion School ID No.: 1819-0078 Naga City, Camarines Sur

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of _____.

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