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Affidavit of Surviving Legal Heirs


Republic of the Philippines )
_____________________ ) SS.
x- - - - - - - - - - - - - - - - - - - - - x

AFFIDAVIT OF SURVIVING LEGAL HEIRS


We,  ____________________, ____________________, ____________________, of legal age, ____________________, ____________________, Filipino and resident of ________________, _______________, ________________, _________________, Philippines, after having been duly sworn to in accordance with the law, depose, and state that:

I, ____________________ is the surviving spouse of the deceased___________________ who died on ________________ at ________________________.

That we, _____________________, _____________________, _____________________, and ____________________, are the only children of ____________________ and __________________.

That we are executing this affidavit to attest to the truth and veracity of the foregoing facts and for all legal intents and purpose that it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands ___ day of ________________, 20 ___ at ______________.



_______________________
  Affiant
(State birthday and relationship to the deceased)
_______________________
  Affiant
(State birthday and relationship to the deceased)
_______________________
  Affiant
(State birthday and relationship to the deceased)
_______________________
  Affiant
(State birthday and relationship to the deceased)
SUBSCRIBED AND SWORN to before me this ______ day ________________ 20 ____, in the City of ___________,Philippines, affiant exhibited to me his/her Government issued ID No. _____________ issued at __________ on ____________ as Component Evidence of Identity (CEI).

Doc. No. _____
Page No. _____
Book No. _____
Series of 2016.



NOTARY PUBLIC


Source: coa.gov.ph

Affidavit COA Forms Government Forms

Affidavit of Pendency/Non-Pendency of Administrative/Criminal Case (Survivorship)


Republic of the Philippines )
_____________________ ) SS.
x- - - - - - - - - - - - - - - - - - - - - x


AFFIDAVIT OF PENDENCY/NON-PENDENCY OF 
ADMINISTRATIVE/CRIMINAL CASE (Survivorship)


I, _______________________________, of legal age, Filipino, widow/widower and with permanent address at ___________________________ after having been duly sworn to in accordance with law, hereby voluntarily depose and say:

  1. That my husband/wife was employed as _______________________________at the Commission on Audit prior to his/her death on __________________________;

  2. That t I am applying for Survivorship benefits effective _______________________;

  3. Pls. check [√]appropriate box

  4.   That there is no pending administrative or criminal case filed against me in any forum

      That there is a pending case against me, details of which are as follows:

       Administrative                   Criminal

    Nature/specific offenses charged: _______________________________

  5. That I am executing this affidavit to attest to the truth of the foregoing facts.
IN WITNESS WHEREOF, I  have set my hand and affixed my signature this _________ day of ______________, 20 ______  at _______________________.



_______________________________
Affiant


SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of ___________, 20 ______, affiant exhibited to me his Government Issued ID __________ No. ______________ issued at __________________ on ___________________.


Doc. No. _____
Page No. _____
Book No. _____
Series of _____



NOTARY PUBLIC


Source: coa.gov.ph

Affidavit COA Forms Government Forms

Affidavit of Undertaking for Terminal Leave (Survivorship)


Republic of the Philippines )
_____________________ ) SS.
x- - - - - - - - - - - - - - - - - - - - - x


AFFIDAVIT OF UNDERTAKING FOR TERMINAL LEAVE (Survivorship)



I, _______________________________, of legal age, Filipino, __________________ and a resident of ___________________________ after having been duly sworn to in accordance with law, hereby voluntarily depose and say:

  1. That I am the __________________ of the late ________________________ who passed away on ___________________ at _____________________________ and that at the time of his/her death was presently employed in the Commission on Audit.

  2. I am applying for Terminal Leave on his/her behalf effective ___________________________________.

  3. That pre-audit of financial transaction of national government agencies, among others, has been lifted per COA Circular 2011-002 dated July 22, 2011;

  4. That should it appear in post-audit there was overpayment in the money value of his/her terminal leave benefits, I am willing to make refund of any excess amount thereon;

  5. That on the other hand, it will appear in post-audit that he/she was underpaid in his/her terminal leave benefits, it is understood that the Commission on Audit shall likewise pay him/her the difference of the amount corresponding to the underpayment; and

  6. That I am executing this affidavit to attest to all above facts.
IN WITNESS WHEREOF, I  have hereunto signed my name below this _________ day of ______________, 20 ______  at _______________________.



_______________________________
Affiant


SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of ___________, 20 ______, affiant exhibited to me his Government Issued ID __________ No. ______________ issued at __________________ on ___________________.


Doc. No. _____
Page No. _____
Book No. _____
Series of _____



NOTARY PUBLIC




Source: coa.gov.ph

Affidavit COA Forms Government Forms

Affidavit of Pendency/Non-Pendency of Administrative/Criminal Case


Republic of the Philippines )
_____________________ ) SS.
x- - - - - - - - - - - - - - - - - - - - - x


AFFIDAVIT OF PENDENCY/NON-PENDENCY 
OF ADMINISTRATIVE/CRIMINAL CASE


I, _______________________________, of legal age, Filipino, with permanent address at _________________________________________________, after having been duly sworn to in accordance with law, hereby voluntarily depose and say:

1. That I am currently/formerly employed as ________________________________ in the Commission on Audit.

2. That I am applying for optional/compulsory retirement to take effect/effective on _______________________;

3. Pls. check [√] appropriate box

  That there is no pending administrative or criminal case filed against me in any forum

  That there is a pending case against me, details of which are as follows:

   Administrative                   Criminal

Nature/specific offenses charged: _______________________________

4. That I am executing this affidavit to attest to the truth of the foregoing facts for the expeditious processing of my retirement benefits.

IN WITNESS WHEREOF, I have set my hand and affixed my signature this _________ day of ______________, 20 ______  at _______________________.



_______________________________
Affiant


SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of ___________, 20 ______, affiant exhibited to me his Government Issued ID __________ No. ______________ issued at __________________ on ___________________.


Doc. No. _____
Page No. _____
Book No. _____
Series of _____.



NOTARY PUBLIC


Source: coa.gov.ph
Affidavit COA Forms

Affidavit of Undertaking for Terminal Leave


Republic of the Philippines )
_____________________ ) SS.
x- - - - - - - - - - - - - - - - - - - - - x


AFFIDAVIT OF UNDERTAKING FOR TERMINAL LEAVE



I, _______________________________, of legal age, Filipino, single/married/widow/widower and a resident of ___________________________ after having been duly sworn to in accordance with law, hereby voluntarily depose and say:

1. That I am presently employed in the Commission on Audit and due for compulsory/optional retirement on ______________________________.

2. That I have applied for Terminal Leave effective _______________________.  

3.  That pre-audit of financial transactions of national government agencies, among others, has been lifted per COA Circular 2011-002 dated July 22, 2011.

4.  That should it appear in post-audit there was overpayment in the money value of my terminal leave, I am willing to refund of any excess amount thereon;

5.  That on the other hand, if it will appear in post-audit that I was underpaid in my terminal leave benefits, it is understood that the Commission on Audit shall pay me the difference of the amount corresponding to the underpayment; and,

6. That I am executing this affidavit to attest to the truth to all the above facts.

IN WITNESS WHEREOF, I have set my hand and affixed my signature this _________ day of ______________, 20 ______  at _______________________.



_______________________________
Affiant


SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of ___________, 20 ______, affiant exhibited to me his Government Issued ID __________ No. ______________ issued at __________________ on ___________________.


Doc. No. _____
Page No. _____
Book No. _____
Series of _____



NOTARY PUBLIC




Source: coa.gov.ph
Affidavit COA Forms

Affidavit for Anti-Graft and Corrupt Practices (Survivorship)


Republic of the Philippines )
_____________________ ) SS.
x- - - - - - - - - - - - - - - - - - - - - x


AFFIDAVIT FOR ANTI-GRAFT AND CORRUPT PRACTICES (RA 3019)
(Survivorship)



I, _______________________________, of legal age, Filipino, widow/widower and presently residing at ___________________________ having been duly sworn to in accordance with law, depose and say:

1. That I am the widow/widower of _______________________________________ who was an employee of the Commission on Audit (COA) until his/her death on ______________________.

2. That I have applied for GSIS survivorship benefits as a surviving spouse effective _____________________

3.   That to the best of my knowledge, my husband/wife has no administrative/criminal investigation/charges against him/her for any offense, defined or penalized under RA 2019, otherwise known as the Anti-Graft and Corrupt Practices Act, as amended, and under the provisions of the Revised Penal Code on Bribery; and

4. That I am executing this affidavit to attest to the truth of the foregoing facts or assertation in compliance with COA Memorandum No. 451 dated March 6, 1973.

IN WITNESS WHEREOF, I have set my hand and affixed my signature this _________ day of ______________, 20 ______  at _______________________.



_______________________________
Affiant


SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of ___________, 20 ______, affiant exhibited to me his Government Issued ID __________ No. ______________ issued at __________________ on ___________________.


Doc. No. _____
Page No. _____
Book No. _____
Series of _____.



NOTARY PUBLIC


Source: coa.gov.ph

Affidavit COA Forms

Affidavit for Anti-Graft and Corrupt Practices


Republic of the Philippines )
_____________________ ) SS.
x- - - - - - - - - - - - - - - - - - - - - x


AFFIDAVIT FOR ANTI-GRAFT AND CORRUPT PRACTICES (RA 3019)



I, _______________________________, of legal age, Filipino, single/married/widow/widower and a resident of ___________________________ after having been duly sworn to in accordance with law, hereby voluntarily depose and say:

1. That I am currently/formerly employed as ________________________________ in the Commission on Audit.

2. That I am retiring/ under RA 1616/PD 1146/RA 8291 to take effect/effective on _______________________. 

3.   That there is no administrative or criminal investigation against me for any offense, defined or penalized under RA 3019, otherwise known as the Anti-Graft and Corrupt Practices Act, as amended, and under the provisions of the Revised Penal Code on Bribery; and

4. That I am executing this affidavit to attest to the truth of the foregoing facts or assertation in compliance with COA Memorandum No. 451 dated March 6, 1973.

IN WITNESS WHEREOF, I have set my hand and affixed my signature this _________ day of ______________, 20 ______  at _______________________.



_______________________________
Affiant


SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of ___________, 20 ______, affiant exhibited to me his Government Issued ID __________ No. ______________ issued at __________________ on ___________________.


Doc. No. _____
Page No. _____
Book No. _____
Series of _____.



NOTARY PUBLIC


Source: coa.gov.ph

Affidavit COA Forms

Sample Billing Error Dispute Letter


[Date]
[Name of Creditor]
[Address]

Dear Sir or Madam:

I am writing to dispute a billing error in the amount of [______] on my account. The amount is inaccurate because [describe the problem]. I am requesting that the error be corrected, that any finance and other charges related to the disputed amount be credited as well, and that I receive an accurate statement.

Enclosed are copies of [use this sentence to describe any information you are enclosing, like sales slips or payment records] supporting my position. Please investigate this matter and correct the billing error as soon as possible.

Sincerely,

[Your name]


Source: consumer.ftc.gov

billing error letter of dispute Letters

Affidavit of Reconciliation of Birth Data


Republic of the Philippines )
Province of ________________ ) SS.
City/Municipality of _______ ) 
x- - - - - - - - - - - - - - - - - - - - - x


AFFIDAVIT OF RECONCILIATION OF BIRTH DATA



I, _______________________________, of legal age, single, Filipino citizen, and with residence at ___________________________ after having been sworn in accordance with law, do hereby depose and state that:

1. I was born to Spouses _______ and _________ of Calbayog City on May 10, 1976;

2. In the birth certificate which I obtained only recently, my family name is spelled as "________________" instead of "_________________" to which I have I have been used to as in my school records, SSS, BIR and other public documents. A copy of said birth certificate which indicated my family name as "_______________" is hereto attached for reference;

3.   The names _________________ and ___________________ belong to one and the same person, the undersigned herein;

4. That I am executing this affidavit in order to attest to the truth of foregoing circumstances and for the purpose of setting the records straight and declaring that ____________________ and _________________________ refer to one and the same person.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this _________ day of ______________, 20 ______  in _______________________.



_______________________________
Affiant


SUBSCRIBED AND SWORN TO before me this _____ day of _________ at ________________ affiant exhibited to his/her competent evidence of identity by way of _________________ issued on __________________ in _______________, Philippines.


Doc. No. _____
Page No. _____
Book No. _____
Series of 2016.


NOTARY PUBLIC
Affidavit

 

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