REPUBLIC OF THE PHILIPPINES)

Province of____________________) S.S.

City/Municipality of_____________)
x---------------------------------------x
AFFIDAVIT OF GUARDIANSHIP OF MINORS (for PAG-IBIG FUND)
I, ________________(name of affiant)____________, Filipino, of legal age, [single]/[married to
_________(name of spouse)_________], and a resident of ___________________(address of
affiant)_______________, after having been duly sworn in accordance with law, hereby depose
and state:
1. That I am the ______________(relationship)______________ of the minor/s named
below who has/have an interest in the Pag-IBIG provident benefits of the late
____________________________________________ payable by the Pag-IBIG Fund;
LIST OF MINORS:
Name
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________

Date of Birth and Age

________________________
________________________
________________________
________________________
________________________

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

3. That the said minor/s is/are under my care and custody;
4. That I am competent to receive in behalf of the said minor/s any amount/s that are due
him/them; and
5. That I am not a stupid person, not an insane, not a vagrant and not a vicious person;
6. That I am not a habitual drunkard and not a habitual criminal;
7. That I have neither abandoned, nor neglected and nor refused to support said minor/s
or caused him/them to commit offenses against the law;
7. That I am executing this affidavit to attest to the truth of the foregoing facts.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____th day of ____________
20___ at ____________, Philippines.

_________________________________
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________ 20___.
Affiant personally came and appeared with _____________(Competent Evidence of
Identity)______ issued by the _________(Government Agency)______ on ___(date)__

at ________(place)_________, bearing his photograph and signature, known to me as the

same person who personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said instrument.

Doc. No. ____

Page No. ____
Book No. ____
Series of 20__

Atty ___________________________________________
Notary Public
Commission Serial No. ____________________________
Notary Public for _______(Province/City)______________
Until December 31, 20__
Office: ______________(address)____________________
Roll No. __________
IBP Lifetime Roll No. _________; __/__/__ ; _(Province)_
PTR No. _________ ; __/__/__ ; _(Province)_
MCLE Compliance Cert. No. __________; __/__/__