REPUBLIC OF THE PHILIPPINES)

Province of____________________) S.S.

City/Municipality of_____________)
x---------------------------------------x

AFFIDAVIT OF GUARDIANSHIP OF MINORS (for PAG-IBIG

FUND)

I, ________________(name of affiant)____________, Filipino, of

legal age, [single]/[married to _________(name of
spouse)_________], and a resident of
___________________(address of affiant)_______________, after
having been duly sworn in accordance with law, hereby depose and
state:

1. That I am the
______________(relationship)______________ of the minor/s
named below who has/have an interest in the Pag-IBIG
provident benefits of the late
____________________________________________ payable
by the Pag-IBIG Fund;

LIST OF MINORS:

Name Date of Birth and Age

______________________
______________________
______________________
______________________
______________________
______________________
______________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________

2. That I am the guardian of the above-named minor/s;

3. That the said minor/s is/are under my care and custody;

4. That I am competent to receive in behalf of the said minor/s

any amount/s that are due him/them; and

5. That I am not a stupid person, not an insane, not a vagrant

and not a vicious person;

6. That I am not a habitual drunkard and not a habitual criminal;

 7. That I have neither abandoned, nor neglected and nor
refused to support said minor/s or caused him/them to commit
offenses against the law;

7. That I am executing this affidavit to attest to the truth of the

foregoing facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____th day of ____________ 20___ at ____________, Philippines.

_________________________________
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________
20___. Affiant personally came and appeared with _____________(Competent
Evidence of Identity)______ issued by the _________(Government
Agency)______ on ___(date)__ at ________(place)_________, bearing his
photograph and signature, known to me as the same person who personally
signed the foregoing instrument before me and avowed under penalty of law to
the whole truth of the contents of said instrument.

Atty _______________________________________
Notary Public
Doc. No. ____ Commission Serial No. __________________
Page No. ____ Notary Public for _______(Province/City)_____
Book No. ____ Until December 31, 20__
Series of 20__ Office: ______________(address)__________
Roll No. __________
IBP Lifetime Roll No. ________; __/__/__ ; (Province)
PTR No. _________ ; __/__/__ ; _(Province)_
MCLE Compliance Cert. No. __________; __/__/__

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