REPUBLIC 

OF THE PHILIPPINES)
CITY OF NAGA . . . . . . . . . . .) S.S.

AFFIDAVIT OF GUARDIANSHIP

I, _________________________, of legal age, widow, Filipino and residing

at _____________________________ after being duly sworn to, in accordance wi
th law, do hereby depose and say:

1. That I am the mother of _______________________, a minor, who has an interest

in the proceeds of insurance on the life of the
late _________________, my deceasedhusband, as well as the GSIS/SSSFund and
Pag-Ibig Fund benefits of the said deceased;

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

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

4. That I am competent to receive on behalf of the said minor the proceeds of

insurance of the deceased, as well as the latter’s benefits under the GSIS/SSS Fund and
Pag-Ibig Fund and any amount due her;

5. 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 or caused her to commit offenses against the law.

6. That I am executing this affidavit to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of September 2022
at Naga City, Philippines.
_______________________
 Affiant

SUBCRIBED AND SWORN to before me this _____day of _________________

at ____________________. Affiants exhibited to me their respective Identification
Cards/Residence Certificates as follows:

Name of Affiant  CTC/ID No. Issued at Issued on / Expiry

___________________ ___________________________

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of _____.