Republic of the Philippines )

Rizal
Province of _____________ ) S. S.
Pililla
Municipality of __________ )
x--------------------------------x

AFFIDAVIT OF LEGAL BENEFICIARY

John Aaron D. Reyta

I, ______________________, of legal age, single, Filipino and a resident of
Brgy. Halayhayin Pililla Rizal
_____________________________, after having been duly sworn to in accordance with
law, hereby depose and say:

1. That I am applying in the Military Service as trainee in the Philippine Army;

2. That as one of my requirements, I am declaring my parents,

________________________ and _____________________ as my legal
Aurora D. Reyta
beneficiaries; Joseph D. Reyta

3. That I am executing this affidavit to attest to the truth of the foregoing and for
whatever lawful purpose that it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of

________________, 2014 at ________________, ________________.

Affiant

SUBSCRIBED AND SWORN to before me this ______ day of

________________, 2014 at ________________, ________________.

Doc. No.
Page No.
Book No.
Series of 2014.