Republic of the Philippines )

City of _________ )
Province of ___________ )S.c.

AFFIDAVIT OF LEGAL BENEFICIARIES

I, ________________, of legal age, Filipino, single and a resident of Brgy. San

Juan ___________________, after having been sworn in accordance with law,
hereby depose and state that:

1. I am applying in the Military Service as a trainee in the Philippine Army;

2. I was born on September 16, 1996 to spouses __________________ and

_______________________;

[The Photocopy of the Certificate of Live Birth is attached as ANNEX “A” and
made an integral part hereof.]

3. I have never contracted any marriage in the Philippines or elsewhere, and

I remain SINGLE to this very day and hour;

[The Photocopy of Affidavit of Being Single is attached as ANNEX “B” and

made an integral part hereof.]

4. I have no children whether legitimate or illegitimate;

5. Accordingly, I am hereby declaring spouses ________________________ and

______________________ as my legal beneficiaries in all insurance that will be due
to me and in all pertinent documents that will need the declaration of legal
beneficiaries; and,

6. I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 21st

day of January 2020 in the City of Ilagan, Isabela.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this 20th day of January

2020 in the City of ___________________. The Identity of the Affiant is established
by his Driver’s License ID with No. ______________________.
_______________________________
Attorney