Republic of the Philippines )

City of Tuguegarao ) s.s

AFFIDAVIT OF SURVIVORSHIP

I, SUSAN T. DARAN, Filipino, of legal age, widow and a resident of

04 Dunkin Drive St., Caggay, Tuguegarao City, after having been duly
sworn in accordance with law, hereby depose and say:

1. That I am the surviving spouse of the late

ALEXANDER P. DARAN, former employee of the Office
of the Provincial Prosecutor, Cabarroguis, Quirino
under the Department of Justice, Manila;

2. That my spouse died on April 22, 2012 and since the

death of my spouse, I have not remarried, cohabited
with another person, or otherwise engaged in a
common-law relationship;

3. I acknowledge that, if granted ,my entitlement to

survivorship benefit from the the Department of
Justice 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;

4. I hereby agree unconditionally to reimburse/return

to the Department of Justice without need of
demand or judicial action, all survivorship benefits I
may still unduly receive after my entitlement thereto
is terminated as stated above;
 5. I am executing this affidavit to attest to the truth of
the foregoing statements in support of my application
for survivorship benefit with the Department of
Justice, Manila and for other legal purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_________________in Tuguegarao City, Philippines.

SUSAN T. DARAN
Affiant
PRC ID No. 0625893

SUBSCRIBED AND SWORN to before me, in the City of Tuguegarao,

this _____________________, affiant personally known to me.

Notary Public

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