REPUBLIC OF THE PHILIPPINES )

CITY OF ________________) SS.

AFFIDAVIT OF GUARDIANSHIP
(for BANK DEPOSITS)
I, ________________________, of legal age a Filipino citizen, married to
________________ and presently residing at ________________________, after having
been duly sworn in accordance with law, hereby depose and say:
1. That, I am the child of _____________________________;
2. That, I am submitting a certified true copy of my Birth Certificate which was
issued by___________________ on __________________;
3. That, _________________ maintained Time Deposit/Savings/Current Accounts
No. _________________ with __________________under the account name
________________ having an amount of Twenty Thousand Dollars ($20, 000. 00);
4. That, I, the only child, hereby lay claim to the deposit insurance due on the
account;
5. That, I shall be held liable to any person, that may be prejudiced by my
representations, in addition to other liabilities, civil or criminal, that may arise therefrom;
hereby releasing and discharging the _______________________ from any all further
obligations in connection with this claim;
6. That, I further undertake to refund _______ the amount paid to me including
interests thereon and indemnify _______, the bank and/or third parties for any loss or
damages occasioned by such payment.
I am executing this affidavit to attest to the truth of the foregoing facts.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of
____________ 2014 at ________________________, Philippines.
________________
Affiant
SUBSCRIBED AND SWORN TO before me, a notary public in and for
______________________ this day of _______________, 2014. The affiant, whom I
identified through the following competent evidence of identity:___________________,
valid from________________ to __________________, issued by ___________________,
personally signed the foregoing instrument before me and avowed under penalty of law tho
the whole truth of the contents of said instrument.
Notary Public
Doc. No.______
Page No. ______
Book No. ______
Series of 2014