Affidavit of Guardianship

Republic of the Philippines
Municipality/City of Balanga
Province of Bataan


I, ___________, after having been sworn to in accordance with law, do hereby depose and say that:

  1. I am of legal age, single/married and a resident of_____________________;
  2. I am the parent/court appointed guardian of_____________________(name of minor);
  3. I am submitting a photocopy of the Birth Certificate of the minor,  ______________ (if parent) or court appointment as guardian of said minor (if judicial guardian);
  4. ________________________ (name of minor) maintained Time Deposit/Savings/Current Accounts No/s. ____________ with _______________ under the account name _____________________________;
  5. I, on behalf of ____________________________ (name of minor)  hereby lay claim to the deposit insurance due on the account;
  6. 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 PDIC from any all further obligations in connection with this claim;
  7. 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.

IN WITNESS WHEREOF, I have hereunto set my mind this ____ day of ___________ at ______________.

Parent or Judicial Guardian

SUBSCRIBED AND SWORN to before me in the Municipality/City of ___________ this ____________ day of _______________________ by _____________________, who has satisfactorily proven his/her identity to me through his/her ___________________ issued on ____________________ in ____________________, , that he/she is the same person who personally signed the foregoing affidavit before me and acknowledged that he/she executed the same

Notary Public

Doc. No. ______:
Page No. ______:
Book No. ______:
Series of ______: