REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ISABELA ) S.S.

MUNICIPALITY OF CABAGAN)

AFFIDAVIT OF NO-RE-MARRIAGE

I, R-JAY G. AGABIN of legal age, widower, Filipino Citizen and resident of Brgy.
Centro, Sto Tomas, Isabela after having been duly sworn to according to law hereby depose and
state:

1) That I am the same person executing this affidavit;

2) That I am the widow of MARICEL D. AGABIN who died on March 29, 2022;

3) That I acknowledge that, if granted my entitlement to survivorship benefit from the GSIS
will be automatically and permanently terminated the moment I remarry, cohabit with
any person or engage in common-relationship;

4) That I am executing this affidavit in order to attest the truthfulness of all the foregoing
statements and for all lawful intent and purposes it may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 19th day of May 2022 at
Cabagan, Isabela.

R-JAY G. AGABIN
Affiant
Valid ID No.: ________________
Issued by: __________________

SUBCRIBED AND SWORN TO BEFORE ME this 19th day of May 2022 in Cabagan,
Isabela, Philippines affiant exhibiting to me his valid ID written below his name as proof of
his identity.

Doc No. _;
Page No. _ ;
Book No. 4__;
Series of 2022;