SAMPLE: MARRIED
Republic of the Philippines)
)
)...s.s.
AFFIDAVIT OF CONFIRMATION
I, JUAN CRUZ DELA CRUZ, a Filipino of legal age, a resident of 123 ABCD ST.,
KAMUNING, QUEZON CITY, a bona fide member of the Philippine National Police with the
rank of Police Master Sergeant and presently assigned at DPRM, RMD after having been
duly sworn to in accordance with law, do hereby depose and says that:
1. Pursuant to this affidavit, I am confirming that the following are my legal
beneficiary/ies and/or heir/s, to wit:
NAME
JUANA DOE DELA CRUZ
JOAN DOE DELA CRUZ
JOHN DOE DELA CRUZ
RELATIONSHIP
WIFE
DAUGHTER
SON
BIRTHDATE
JAN 01, 1985
FEB 01, 2013
MAR 01, 2016
2. My relationship with person/s whose name/s is/are listed above is/are borne out by
the fact that I am the lawful spouse and the father/mother of the afore-mentioned
child/children as evidenced by the attached advisory on marriages, marriage contract
and birth certificate/s;
3. That all the documents I have attached and submitted to support the updating of my
Declared Legal Beneficiary/ies are original copies obtained from Philippine Statistic
Authority (PSA); and
4. I hold myself criminally and administratively liable for perjury and dishonesty should
any statements made herein/documents submitted herewith are inaccurate or later
found to be false and in violation of law.
AFFIANT SAYETH NAUGHT:
Signature PNP Personnel
Affiant
Contact No.
SUBSCRIBED AND SWORN to before me this
, Philippines
Doc. No.
Page No.
Book No.
Series No.
day of
at
SAMPLE: SOLO PARENT
Republic of the Philippines)
)
)...s.s.
AFFIDAVIT OF CONFIRMATION
I, JUAN CRUZ DELA CRUZ, a Filipino of legal age, a resident of 123 ABCD ST.,
KAMUNING, QUEZON CITY, a bona fide member of the Philippine National Police with the
rank of Police Master Sergeant and presently assigned at DPRM, RMD after having been
duly sworn to in accordance with law, do hereby depose and says that:
1. Pursuant to this affidavit, I am confirming that the following are my legal
beneficiary/ies and/or heir/s, to wit:
NAME
JOAN DOE DELA CRUZ
JOHN DOE DELA CRUZ
RELATIONSHIP
DAUGHTER
SON
BIRTHDATE
FEB 01, 2013
MAR 01, 2016
2. My relationship with person/s whose name/s is/are listed above is/are borne out by
the fact that I am the lawful father/mother of the afore-mentioned child/children as
evidenced by the attached cenomar and birth certificate/s;
3. That all the documents I have attached and submitted to support the updating of my
Declared Legal Beneficiary/ies are original copies obtained from Philippine Statistic
Authority (PSA); and
4. I hold myself criminally and administratively liable for perjury and dishonesty should
any statements made herein/documents submitted herewith are inaccurate or later
found to be false and in violation of law.
AFFIANT SAYETH NAUGHT:
Signature PNP Personnel
Affiant
Contact No.
SUBSCRIBED AND SWORN to before me this
, Philippines
Doc. No.
Page No.
Book No.
Series No.
day of
at
SAMPLE: SINGLE
Republic of the Philippines)
)
)...s.s.
AFFIDAVIT OF CONFIRMATION
I, JUAN CRUZ DELA CRUZ, a Filipino of legal age, a resident of 123 ABCD ST.,
KAMUNING, QUEZON CITY, a bona fide member of the Philippine National Police with the
rank of Police Master Sergeant and presently assigned at DPRM, RMD after having been
duly sworn to in accordance with law, do hereby depose and says that:
1. Pursuant to this affidavit, I am confirming that the following are my legal
beneficiary/ies and/or heir/s, to wit:
NAME
JOAN DOE DELA CRUZ
JOHN DOE DELA CRUZ
RELATIONSHIP
MOTHER
FATHER
BIRTHDATE
FEB 01, 1950
MAR 01, 1952
2. My relationship with person/s whose name/s is/are listed above is/are borne out by
the fact that I am the lawful child of the afore-mentioned parent/s as evidenced by the
attached cenomar and birth certificate/s;
3. That all the documents I have attached and submitted to support the updating of my
Declared Legal Beneficiary/ies are original copies obtained from Philippine Statistic
Authority (PSA); and
4. I hold myself criminally and administratively liable for perjury and dishonesty should
any statements made herein/documents submitted herewith are inaccurate or later
found to be false and in violation of law.
AFFIANT SAYETH NAUGHT:
Signature PNP Personnel
Affiant
Contact No.
SUBSCRIBED AND SWORN to before me this
, Philippines
Doc. No.
Page No.
Book No.
Series No.
day of
at