Republic of the Philippines )

Province of Negros Oriental..) S.S.

Municipality of Sibulan)

AFFIDAVIT OF UNDERTAKING

I, FULGENCIA PALIGSA JAIME, of legal age, Filipino, widow, and a resident of

Bonawon, Siaton, Negros Oriental, after having been sworn to in accordance with law, do hereby
depose and state:

1. I am the wife of the late JESSIE E. JAIME who died on January 21, 2020 in
Cong. Lamberto L. Macias Memorial Hospital, Siaton, Negros Oriental;

2. My deceased husband was a bona fide member of the Armed Forces and Police
and Loan Association, Inc. (AFPSLAI);

3. Consequently, I am requesting AFPSLAI authorities to allow me to receive the

proceeds of the termination of the deceased’s account for my benefit and also for the benefit of
the other heirs;

4. I will hold myself criminally and civilly responsible for any liability that may
arise in connection with my receipt of the above-cited proceeds or benefit and further free
AFPSLAI from liability relative thereto;

5. That I executed this affidavit to attest to above-stated facts for whatever legal
purpose it may deem serve and for the purpose of securing Building Permit;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 27 th day of July

2023, in Sibulan, Negros Oriental, Philippines.

FULGENCIA PALIGSA JAIME

Affiant

SUBSCRIBED AND SWORN to before me this 27 th day of July 2023, in Sibulan,

Negros Oriental, Philippines, personally appeared, FULGENCIA PALIGSA JAIME, who
exhibited to me her AFP ID with AFPICS NR. OTAG-LB-713790-3377, and is personally
known to me, and she attested that she is the same person who personally signed before me the
foregoing affidavit and acknowledged that she voluntarily executed the same.

Doc No. 172;

Page No. 36;
Book No. II;
Series of 2023.