(This 

affidavit is required as part of our PVAO Validation. No need for it to be notarized.)

 
 
AFFIDAVIT OF SURVIVING SPOUSE
 
 
I, Joaquina Garcia Jose, Filipino, of legal age, widow / widower, with address at  Paguiruan,
Floridablanca, Pampanga  and  the  following  contact  number 09151688339, after having sworn
in accordance with law, hereby depose and state:
 
I  am  a  widow  /  widower of  Guillermo Montemayor Jose who  was  a PVAO pensioner /
veteran who died on September 04, 1998 at Floridablanca, Pampanga;
 
I hereby declare that, since the death of my spouse (veteran), I have not remarried, cohabited
with another person, or otherwise engaged in a common-law relationship.  I acknowledge that
my entitlement to survivorship pension from the PVAO will automatically and permanently
terminate the moment that I re-marry, co-habit with any person/engage in a common-law
relationship, whether of the same or opposite sex, or, whether or not such a relationship is still
subsisting.  I hereby agree unconditionally to reimburse/return to the PVAO, without the need of
demand or judicial action, all survivorship benefits I may still unduly receive after my
entitlement thereto is terminated as stated above.
 
Pursuant  to  and  consistent  with  the  declarations  I  made  above,  I  hereby   authorize  the
PVAO to  secure  information  regarding  my  civil  status  from  the  Philippine Statistics
Authority (PSA)  or other relevant  government offices or even  private entities.
 
I am executing this affidavit to attest to the truth of the foregoing statements in support of my
continuous receipt for survivorship pension with the PVAO under Republic Act No.  6948 Sec.
11, and for other legal purposes, it may serve. I fully understand that any inaccurate and
untruthful statement in this affidavit shall render me criminally and civilly liable.
 
 
 
                                                                                    __________________________________
                                                                                        Affiant/Name of Pensioner & Signature
(If the pensioners can no longer sign,
you may opt to use her thumbmark.)
 
                                                                                 
   Date:  _____________________________