Republic of the Philippines
Municipality/City of Balanga
Province of Bataan
AFFIDAVIT OF GUARDIANSHIP
I, ___________, after having been sworn to in accordance with law, do hereby depose and say that:
- I am of legal age, single/married and a resident of_____________________;
- I am the parent/court appointed guardian of_____________________(name of minor);
- 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);
- ________________________ (name of minor) maintained Time Deposit/Savings/Current Accounts No/s. ____________ with _______________ under the account name _____________________________;
- I, on behalf of ____________________________ (name of minor) hereby lay claim to the deposit insurance due on the account;
- 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;
- 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
Doc. No. ______:
Page No. ______:
Book No. ______:
Series of ______: