(This affidavit is required as part of our PVAO Validation. No need for it to be notarized.

It needs to be accomplished first before we can provide your online schedule)

AFFIDAVIT OF SURVIVING SPOUSE

I, ____________________________, Filipino, of legal age, widow / widower, with address at

__________________________________________ and the following contact number
_______________________, after having sworn in accordance with law, hereby depose and
state:

I am a widow / widower of __________________________________who was a PVAO

pensioner / veteran who died on __________________ at __________________________;

I hereby declare that, since the death of my spouse (veteran), I have not remarried,
cohabited with another person, or otherwise engaged in a common-law relationship. I
acknowledge that my entitlement to survivorship pension from the PVAO will
automatically and permanently terminate the moment that I re-marry, co-habit with any
person/engage in a common-law relationship, whether of the same or opposite sex, or,
whether or not such a relationship is still subsisting. I hereby agree unconditionally to
reimburse/return to the PVAO, without the need of demand or judicial action, all
survivorship benefits I may still unduly receive after my entitlement thereto is terminated
as stated above.

Pursuant to and consistent with the declarations I made above, I hereby authorize
the PVAO to secure information regarding my civil status from the Philippine
Statistics Authority (PSA) or other relevant government offices or even private entities.

I am executing this affidavit to attest to the truth of the foregoing statements in support of
my continuous receipt for survivorship pension with the PVAO under Republic Act No.
6948 Sec. 11, and for other legal purposes, it may serve. I fully understand that any
inaccurate and untruthful statement in this affidavit shall render me criminally and civilly
liable.

__________________________________
Affiant/Name of Pensioner & Signature

Date: _____________________________