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Sworn Declaration of Being Affected by Calamity (HQP-HLF-453)
Sworn Declaration of Being Affected by Calamity (HQP-HLF-453)
HQP-HLF-453
SWORN DECLARATION OF BEING AFFECTED BY CALAMITY
I, _________(name of member)_____________, of legal age, ____(civil status)__,
Filipino and with permanent address at __________________________________,
hereby certify that:
1. I am a Pag-IBIG Fund member in good standing;
2. I am applying for a home rehabilitation/reconstruction loan with Pag-IBIG Fund;
3. I am a victim of _______(name or nature of calamity)____ , and my
house/residence at ________________________________________________
was among those destroyed or damaged on ___________________.
4. Due to the above-stated calamity, I have suffered the following damages/effects
in my property:
(describe damages/effects of calamity)
of
of
NOTARY PUBLIC
Doc. No. _______;
Page No. _______;
Book No. _______;
Series of _______.
(Rev. 00, 12/2014)