AFFIDAVIT OF AUTHENTICITY

I, __________________________, of legal age, Filipino, single/married/widow/er and with

residence and postal address at _________________________________, after being duly sworn
to in accordance with law, depose and state that:

That I am the legitimate claimant wife/husband/sibling/son/daughter/mother/father of the late

_________________________________.

That all documents I have submitted hereto to support my claim are genuine and authentic.

That I hold myself liable for perjury, falsehood, misrepresentation or omission or any
act of dishonesty for any fraudulent, false, and tampered documents that I have submitted.

That I agree to the automatic stoppage of processing of my claims for retirement benefits if
any of the attached documents are false or fraudulent;

That, I am fully aware that any misrepresentation is a ground for prosecution.

That I attest to the truthfulness of this undertaking and I submit to the legal and administrative
consequence thereof if the statements above are wanting in truth and substance.

FURTHER AFFIANT SAYS NONE:

__________________________
Affiant (Signature over printed name)

Contact Number : _______________

SUBSCRIBED AND SWORN to before me in the _______________________ this ____ day of

______________, _______ by _______________________, who has satisfactorily proven to me
his/her identity through his/her______________________________, valid until
________________, that he/she is the same person who is personally signed before me the
foregoing Affidavit of Guardianship and acknowledged that he/she executed the same.

NOTARY PUBLIC
Doc. No. ____________;
Page No. ____________;
Book No. ____________;
Series of ____________