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 ___________ day of ________________ at ___________________________________, Philippines Doc. No. Page No. Book No. Series No. 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 ___________ day of ________________ at ___________________________________, Philippines Doc. No. Page No. Book No. Series No. 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 ___________ day of ________________ at ___________________________________, Philippines Doc. No. Page No. Book No. Series No.
