Republic of the Philippines)

City of ________________) S.S

AFFIDAVIT OF UNDERTAKING
I/WE, (Name of Client Wife/Husband/Siblings/Parents/Children/Nieces/Nephews), all
of legal age, married/single, Filipino, with residence at (Address of Residence), (hereinafter
referred as NOK) after having been sworn in accordance with law, hereby depose and state that:

1. OFW (Name of OFW) (“Employee”), with Philippine Passport No. _____________ issued
on (Date if Issue), died in (Place of death)_______ on (Date of Death).
Employee died without leaving any last will and testament, has no debts, and has no
other surviving legal heirs except for the following:

Relationship to the Employee

Name of Legal Heir (Indicate if Minor or Legal Age)

2. The employer of the Employee requested the Philippine Embassy in Riyadh to transfer
to the NOK the amount SAUDI RIYALS (SAR)_______________________ as death
benefit/end- of-service benefits (ESB), with authority given to the Department of
Foreign Affairs to identify the NOK on the basis of appropriate Philippine government
documents.
3. (For minors) I, (name of mother), the mother and legal guardian of minor child(ren) of
the employee above listed. I am authorized to receive the share of my minor child(ren)
from death benefits/ESB.
4. The NOK requests and authorized the Office of the Undersecretary for Migrant Workers
Affairs (OUMWA) to release the Philippine peso equivalent of the death benefits/ESB
minus bank and other remittance charges as follows: (Please check chosen box)
a. [ ]For claiming in person by NOK
b. [ ]Bank-to-bank transfer to (Name of Bank, Branch Account Number) under the
name of (Name of bank account holder who must be one of the NOK).

5. The NOK shall immediately distribute to all beneficiaries of the Employee whose
filiation is supported by Philippine government documents. If another beneficiary who
was not earlier identified and did not receive a share in the death benefits/ESB surfaces,
the NOK shall return to OUMWA the amount meant for the new beneficiary within 10
days from notice.
6. The NOK affirms that they have no claim against the Department of Foreign Affairs or
any of its officers or employees. In the event that another beneficiary surface, the NOK
shall keep free from harm and claim the Department of Foreign Affairs and defend the
latter against any proceedings that the new beneficiary may institute.
7. This Affidavit of Undertaking is executed to attest to the truth of the foregoing and
binds the NOK with the undertaking aforementioned. The NOK shall be liable for
 perjury, estafa, and other related felonies or crimes for any falsehood in this affidavit or
for non-performance of the undertakings stated therein which we assume with full
understanding of its consequences.

_________________ _______________________

(Name of affiant 1) (Name of affiant 2)

(Government Issued ID) (Government

Issued ID)

__________________ _____________________

(Name of Affiant 3) (Name of Affiant 4)

(Government Issued ID) (Government

Issued ID)

SUBCRIBED AND SWORN to before me this ____ day of ______, affiants exhibiting to me
their identification documents indicated below their respective names.

________________

(Subscribing Officer)

Document No. _________

Page No. _______

Book No. _______

Series of 2020