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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF OCCIDENTAL MINDORO) S.S


MUNICIPALITY OF SABLAYAN)

AFFIDAVIT OF SURVIVING LEGAL HEIRS

We ____________________, ____________________, ____________________, of


legal age, ____________________, ____________________, Filipino and resident of
________________, _______________, ________________, _________________,
Philippines, after having been duly sworn to in accordance with the law,
depose, and state that:

1. I, ____________________ is the surviving spouse of the


deceased___________________ who died on ________________ at
________________________.

2. That we, _____________________, _____________________,


_____________________, and ____________________, are the only children of
____________________ and __________________.

3. That we are executing this affidavit to attest to the truth and veracity
of the foregoing facts and for all legal intents and purpose that it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands ___ day of


________________, 20 ___ at ______________.

___________________ ____________________
Affiant Affiant
(State birthday and relationship to the deceased) (State birthday and relationship to the deceased)

____________________ _____________________
Affiant Affiant
(State birthday and relationship to the deceased) (State birthday and relationship to the deceased)

____________________
Affiant
(State birthday and relationship to the deceased)
SUBSCRIBE AND SWORN to me before this ____ day of ___________, at
______________ on _________, affiant exhibited to me his/her Government issued ID
__________No._________________ issued at __________ on ____________.

Doc. No. _________


Page No. _________
Book No. _________
Series of _________ NOTARY PUBLIC

REPUBLIC OF THE PHILIPPINES)


PROVINCE OF OCCIDENTAL MINDORO) S.S
MUNICIPALITY OF SABLAYAN)
AFFIDAVIT OF GUARDIANSHIP

I, _________________, of legal age, single/married/widow,


Filipino citizen, and presently residing at _____________________, after
having been duly sworn to in accordance with law, do hereby depose and
say:

1. That I am the ___(state relationship)__ and guardian of the following


minor/s who has / have an interest in the _______________ of the
late _________________________ payable by ________________;

Full Name of Minor/s Date of Birth Age


_______________ _________ ______
_______________ _________ ______
_______________ _________ ______

2. That the above mentioned minor/s is/are under my care and custody;

3. That I am competent to receive in behalf of the said minor/s any amount/s


due him/them; and

4. 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/s or caused
him/them to commit offenses against the law.

5. That I am executing this affidavit to attest to the truth of all the foregoing
statements and for whatever legal purpose it may serve.

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


of _______ 2014 at ______________, Philippines.

_______________
_
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ______


2014 in _________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of _______________ issued at ___________
on ________________.

Doc No. : _____


Page No.: ______
Book No.: ______
Series of 2014 Notary Public

REPUBLIC OF THE PHILIPPINES)


PROVINCE OF OCCIDENTAL MINDORO) S.S
MUNICIPALITY OF SABLAYAN)
AFFIDAVIT OF SURVIVING SPOUSE WITH DECLARATION OF NO
REMARRIAGE

I, _____________________________, Filipino, of legal age, widow / widower,


with address at ___________________________________________ and the
following contact number _______________________, after having sworn in
accordance with law, hereby depose and state: I am a widow /
widower of ___________________________________ who was a GSIS
member / retiree who died on ___________________ at
_________________________________;

I hereby declare that, since the death of my spouse, I have not


remarried, cohabited with another person, or otherwise engaged in a
common-law relationship. I acknowledge that, if granted, my entitlement
to survivorship benefit from the GSIS will automatically and
permanently terminate the moment that I re-marry, co-habit with any
person/engage in a common-law relationship, whether of the same or
opposite sex, or, whether or not such a relationship is still subsisting. I
hereby agree unconditionally to reimburse/return to the GSIS, without
need of demand or judicial action, all survivorship benefits I may still
unduly receive after my entitlement thereto is terminated as stated
above. Pursuant to and consistent with the declarations I made above,
I hereby authorize the GSIS to secure information regarding my civil
status from the National Statistics Office (NSO) or other relevant
government offices or even private entities.

I am executing this affidavit to attest to the truth of the foregoing


statements in support of my application for survivorship benefit with the
GSIS under Republic Act No. 8291 and for other legal purposes it may
serve. I fully understand that any inaccurate and untruthful statement
in this affidavit shall render me criminally and civilly liable.

______________________
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of


_________________20__, in the City of Pasay, Philippines, affiant exhibiting to me
his/her __________________________as Competent Evidence of Identity (CEI):