Professional Documents
Culture Documents
DEPOSITS)
REPUBLIC OF THE PHILIPPINES )
_____________________________ ) SS.
I, _____________________________, Filipino, of legal age, single/married
to _____________________________,
and
a
resident
of _____________________________, after having been duly sworn in accordance
with law, hereby depose and say:
1. I am the parent/court appointed guardian of _____________________________;
2. I am submitting a certified true copy of the Birth Certificate of the minor/court
appointment as guardian of said minor;
3. _____________________________ maintained Time
Deposit/Savings/Current Accounts
No/s. ___________________ with _____________________________ under the
account name _____________________________;
4. I, on behalf of _____________________________ hereby lay claim to the deposit
insurance due on the account;
5. 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 Philippine Deposit Insurance Corporation (PDIC) from
any all further obligations in connection with this claim;
6. I further undertake to refund PDIC the amount paid to me including interests
thereon and indemnify PDIC, 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.