Republic of the Philippines)

Province of Benguet )
La Trinidad ) s.s

AFFIDAVIT OF CONFIRMATION

I, , a Filipino of legal age, a resident of

, a bonifide member of the Philippine
National Police with the rank of and presently assigned at office
of the , PROCOR after having been duly sworn to
in accordance with law, do hereby depose and say that:

1. Pursuant to this affidavit, I am confirming that the following are my legal

beneficiary/ies and/or heir/s to wit:

NAME RELATIONSHIP DATE OF BIRTH

2. My relationship with the person whose name are/is listed above are borne out by the
fact that I am the lawful spouse and the father/mother of the afore-mentioned
child/children as evidenced by the attached advisory on marriage, marriage contract
and birth certificate/s;

3. That all the documents I have attached and submitted to support the updating of my
Declared Legal Beneficiary/ies are original copies obtained from Philippine Statistics
Authority (PSA); and

4. I hold myself criminally and admiratively liable for perjury and dishonesty should any
statements made here/documents submitted herewith are inaccurate or later found
to be false and in violation of law.

AFFIANT SAYETH NAUGHT:

(Affiant)
Contact No.

SUBSCREIBED AND SWORN to before me this day of 2020 at

, Philippines.

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