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    Affidavit of Claimant

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    chelissamaerojas
    Ramil Juablar Rodriguez executed an affidavit to claim insurance benefits from St. Peter's Life Insurance Plan for the death of his late wife, Carmenchu L. Rodriguez. Ramil was the spouse of Carmenchu, who died on July 9, 2017 in Ormoc City, Leyte. Carmenchu was a member of St. Peter's and had designated Ramil and their two minor children, Athena and Aldrich, as beneficiaries. As the children's legal guardian, Ramil will process, fill out, claim, and receive the insurance benefits on their behalf.

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    Affidavit of Claimant

    Uploaded by

    chelissamaerojas
    6K views1 page
    Ramil Juablar Rodriguez executed an affidavit to claim insurance benefits from St. Peter's Life Insurance Plan for the death of his late wife, Carmenchu L. Rodriguez. Ramil was the spouse of Carmenchu, who died on July 9, 2017 in Ormoc City, Leyte. Carmenchu was a member of St. Peter's and had designated Ramil and their two minor children, Athena and Aldrich, as beneficiaries. As the children's legal guardian, Ramil will process, fill out, claim, and receive the insurance benefits on their behalf.

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    Ramil Juablar Rodriguez executed an affidavit to claim insurance benefits from St. Peter's Life Insurance Plan for the death of his late wife, Carmenchu L. Rodriguez. Ramil was the spouse of Carmenchu, who died on July 9, 2017 in Ormoc City, Leyte. Carmenchu was a member of St. Peter's and had designated Ramil and their two minor children, Athena and Aldrich, as beneficiaries. As the children's legal guardian, Ramil will process, fill out, claim, and receive the insurance benefits on their behalf.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    6K views1 page

    Affidavit of Claimant

    Uploaded by

    chelissamaerojas
    Ramil Juablar Rodriguez executed an affidavit to claim insurance benefits from St. Peter's Life Insurance Plan for the death of his late wife, Carmenchu L. Rodriguez. Ramil was the spouse of Carmenchu, who died on July 9, 2017 in Ormoc City, Leyte. Carmenchu was a member of St. Peter's and had designated Ramil and their two minor children, Athena and Aldrich, as beneficiaries. As the children's legal guardian, Ramil will process, fill out, claim, and receive the insurance benefits on their behalf.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines )

    Province of Leyte ) S.S.


    Municipality of Villaba )
    x----------------------------------x

    AFFIDAVIT
    I, RAMIL JUABLAR RODRIGUEZ, of legal age, Filipino, widow and a resident of
    Panganiban St., Poblacion del Norte, Villaba, Leyte, Philippines, after having been duly sworn to
    in accordance with law, do hereby depose and state that:

    1. I am the spouse of the late CARMENCHU L. RODRIGUEZ who died on July 9, 2017 in
    OSPA, Ormoc City, Leyte. A copy of our Marriage Certificate is herein attached as Annex A.

    2. My deceased wife, CARMENCHU L. RODRIGUEZ, was a member of St. Peters Life


    Insurance Plan, where she made myself and our two children namely: ATHENA MAY L.
    RODRIGUEZ, 12 years old and ALDRICH L. RODRIGUEZ, 11 years old, the beneficiaries
    thereof.

    3. Because our children-beneficiaries are all minors, I will be the one to process, fill-up, claim
    and receive their insurance benefits from St. Peter, Palompon Branch, Palompon, Leyte.

    4. I execute this affidavit to certify and attest to the truth of the foregoing facts and to process
    our claim with the St. Peters Life Insurance Plan as beneficiaries of my late wife, CARMENCHU
    L. RODRIGUEZ.

    5. This Affidavit is executed for whatever legal purpose/s that it may serve.

    IN WITNESS WHEREOF, I have set my hand this 26th day of July, 2017 at Villaba,
    Leyte.

    RAMIL JUABLAR RODRIGUEZ


    Affiant
    Identification Card No. ______________
    Issued On: ______________
    Issued At: ______________

    SUBSCRIBED AND SWORN to before me, this 26th day of July, 2017 at Villaba, Leyte,
    by the Affiant who is personally known to me (or whom I have identified through competent evidence
    of identity) and who exhibited his Identification Card as indicated above.

    .
    NOTARY PUBLIC

    Doc. No. ______;


    Page No. ______;
    Book No.______;
    Series of 2017.

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