REPUBLIC OF THE PHILIPPINES)

) Sci.

AFFIDAVIT OF PARENTAL CARE & CUSTODY

KNOW ALL MEN BY THESE PRESENTS:

I, ________________________, Filipino, of legal age, with residence and

postal address at ________________________, after having been sworn in
accordance with law hereby depose and state:

That I am the legal guardian of ________________________who was

born on December 8, 2006 at Makati City;

That I have been the guardian of my child ever since he was born up to
present.

That I file this affidavit with the (“Manulife Philippines”), with the
request that I be allowed to present the aforementioned child in claiming benefit
under Policy No. ______________ issued on the life of
________________________.

That I am executing this Affidavit of Parental Care & Custody to attest to

the truth of all the foregoing and for all legal purpose it may serve.

IN WITNESS WHEREOF, I have affixed my signature this

________________ at ________________________.

________________________

SUBSCRIBED and SWORN to before me this ________________,

affiant exhibiting to me her Non-Professional Driver’s License No.
________________ as competent proof of her identity.

NOTARY PUBLIC
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2022.