AFFIDAVIT OF GUARDIANSHIP

I, _____________________, of legal age, Filipino, single and

a resident of __________________ after having been duly sworn to in
accordance with law, depose and state that:
1. I am the mother of the minor named __________________ who
has an interest in the Benefits Claim or Insurance Claim of the late
_________________ payable by the Philippine National Police;

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

3. The said minor is under my care and custody and I am also

responsible for providing the child’s food, clothing and his other basic
needs;

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

due him;
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 or caused him 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 minor,
and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this _____
day of _____________________.
_____________________
Affiant
_________________

SUBSCRIBED AND SWORN TO before me this _______________

at __________________. The affiant personally appeared before me
presenting her identification card as indicated above.

WITNESS MY HAND AND SEAL.

Doc. No.
Page No.
Book No.
Series of 2020