Republic of the Philippines)

City of ____ . . . . . . . . . . . )Sc.

Affidavit of Undertaking

I, ______, of legal age, Filipino, widow, and a resident of ______, after having
sworn to an oath as required by law, hereby depose and say:

1] That I am the wife of the Late, ______, who died on March 18, 2021 in _____

2] That my late husband, was a bonafide member of the Armed Forces and
Police Savings and Loan Association Inc. (AFPSLAI) hence, the undersigned being the
lawful claimant of the said member, is entitled to whatever claims/benefits due to me
arising from the death of my late husband, ______;

3] That consequently, I am requesting AFPSLAI authorities to allow me to

receive the said claims/benefits;

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

IN WITNESS WHEREOF, I have hereunto affixed my hand this 24 th day of

August 2022 in _____.

________________
Affiant

SUBSCRIBED AND SWORN to before me this 24th day of August 2022 in

_____.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2023.