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    Affidavit of Surviving Children

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    Angela Canares
    This affidavit is made by the legal guardian of a minor child applying for survivorship benefits from the GSIS. The guardian attests that they are the [relationship] of the deceased GSIS member/retiree and that the child is under 18 years old. The guardian acknowledges that the child's benefits will terminate at age 18 and makes themselves liable for any payments received after that point. The guardian signs to affirm the truth of these statements in support of the child's application under Republic Act 8291.

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    Affidavit of Surviving Children

    Uploaded by

    Angela Canares
    838 views1 page
    This affidavit is made by the legal guardian of a minor child applying for survivorship benefits from the GSIS. The guardian attests that they are the [relationship] of the deceased GSIS member/retiree and that the child is under 18 years old. The guardian acknowledges that the child's benefits will terminate at age 18 and makes themselves liable for any payments received after that point. The guardian signs to affirm the truth of these statements in support of the child's application under Republic Act 8291.

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    Affidavit of Surviving Children; notarial doc

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    This affidavit is made by the legal guardian of a minor child applying for survivorship benefits from the GSIS. The guardian attests that they are the [relationship] of the deceased GSIS member/retiree and that the child is under 18 years old. The guardian acknowledges that the child's benefits will terminate at age 18 and makes themselves liable for any payments received after that point. The guardian signs to affirm the truth of these statements in support of the child's application under Republic Act 8291.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    838 views1 page

    Affidavit of Surviving Children

    Uploaded by

    Angela Canares
    This affidavit is made by the legal guardian of a minor child applying for survivorship benefits from the GSIS. The guardian attests that they are the [relationship] of the deceased GSIS member/retiree and that the child is under 18 years old. The guardian acknowledges that the child's benefits will terminate at age 18 and makes themselves liable for any payments received after that point. The guardian signs to affirm the truth of these statements in support of the child's application under Republic Act 8291.

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    Annex A - 3

    GSIS Form No. SURV-2011-02-004


    Date Revised: 2010-03-16

    REPUBLIC OF THE PHILIPPINES)


    PASAY CITY
    )S.S.

    AFFIDAVIT OF LEGAL/CERTIFIED GUARDIAN


    OF MINOR DEPENDENT CHILD
    I, __________________________________________________________________, of
    legal age, Filipino, with address at ___________________________________________ and the
    following contact number _______________________, after having sworn in accordance with law,
    hereby depose and state:
    I am the __________________ (state relationship with the child, i.e. father/mother, etc.)
    and legal guardian of _____________ (name of child), a child of the late
    ___________________________________, who was a GSIS member / retiree, who died on
    ___________________ at _________________________________;
    I hereby declare that the above-named child is the youngest (or, second youngest/third
    youngest, etc.) of the deceased; that he/she is not more than 18 years of age.
    I am fully aware that if the said child is granted survivorship benefit by the GSIS, his/her
    entitlement thereto will automatically and permanently terminate the moment he/she is over
    eighteen. Consequently, I hereby unconditionally make myself personally and solidarily liable with
    the child for whatever survivorship benefit the latter may still unduly receive from the GSIS after
    his/her entitlement thereto is terminated as stated above.
    I am executing this affidavit to attest to the truth of the foregoing statements in support of
    the application for survivorship benefit of ___________ (name of child) under Republic Act No.
    8291 and for what 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
    SUBSCRIBED AND SWORN to before me this ______ day of _________________20__, in
    the City of Pasay, Philippines, affiant exhibiting to me his/her ______________________as
    Competent Evidence of Identity (CEI):
    NOTARY PUBLIC
    Doc. No.
    Page No.
    Book No.
    Series of

    :
    :
    :
    :

    ___________
    ___________
    ___________
    ___________

    Until Dec. 31, 20___


    PTR No. : _________________
    IBP No. : _________________
    Roll No. : _________________

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