(This affidavit ix required as part of our PVAO Validation.) AFFIDAVIT OF SURVIVING SPOUSE Fipina, of legal age. widow / vadower, with address at and the following contact mumber aiier having sworn in socordance with law, hereby depose and ate Tam awidow | mdewerof tho wes PVA, pensioner / veteran who died on Thereby declare that since the death of my spouse (veteran), 1 have not remamed, cohsbuted vwith another person, or otherwise eagaged in a common-law relationship. | acknowledge thet my eabtlemest to survivorship pension fom the PVAO will automatically and permanently terminate the moment that [ remarry, co-habst with any persomfengage in a common-law felationship, whether of the same or opposite sex or, whether or aot such a relationshup as sull aabaiog. {her agree mncoadinoadly i reumbusectm to the PYAD,wihow the nee of wand or judiaa ackon all suraivorship benefits 1 may stil unduly recewve after my pil Conueienie ated above Purruant to and connstent with the declarstions I made above, | hereby authonze the PVAO to secure information regarding my av mates fom the Phulippine Steasticr ‘Authonty (PSA) er other relevant. goverment offices or even private entities 1am execubing this affidavit to attest to the truth of the foregoing statements in support of my continuous recapt for suvivership pension with the PVAO under Republic Act Na 6948 Sec LL, and for other legal purposes it may serve. 1 fully undermend that say anaccurate and vatruthial statement in this aifidavt shal render me cnaunally and avilly lreble ‘AfbsatName of Pennoner & Signature Date