HQP-PFF-028 (V04, 08/2018)

AFFIDAVIT OF GUARDIANSHIP

I, __Alecia M. Casayuran___, of legal age, Filipino, single/married/widow/er and with

residence and postal address at _29 Champaca St. Brgy.Sta. Lucia Pasig City_, after
being duly sworn to in accordance with law, depose and state that:

1. I am the __Mother_____ (relationship) of the minor/s named below who

has/have an interest in the Home Development Mutual Fund (Pag-IBIG Fund
Provident Benefits Claim/Insurance Claim of the late
____________________ payable by the Pag-IBIG Fund/Insurance Company.

NAME OF MINOR DATE OF BIRTH AGE

________Cholip M. Casayuran________ ___May 5, 2002_____ 20Yrs.Old_
_________________________________ __________________ _________
_________________________________ __________________ _________
_________________________________ __________________ _________
_________________________________ __________________ _________

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

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

4. I am competent to receive in behalf of the said minor/s any amount/s due

him/her/them;

5. I have not been diagnosed nor committed to a hospital or institution for

imbecile, insane, a vagrant or vicious person. I am not a habitual drunkard or
a habitual criminal, and have not abandoned, neglected or refused to support
said minor/s or caused him/her/them to commit offenses against the law; and

6. I am executing this affidavit to confirm and affirm the foregoing facts and to
prove that I am the legal guardian of the above-named minors, and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _27_ day of

___March____, 2023_ at __Pasig City_________________.

___________________
AFFIANT