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    Affidavit of Surviving Spouse

    Uploaded by

    Kelee
    The affidavit is from a surviving spouse applying for survivorship benefits from GSIS. It states that the affiant is the widow/widower of a deceased GSIS member/retiree. The affiant declares they have not remarried or cohabited since their spouse's death. They acknowledge benefits will terminate if they remarry or cohabit. The affiant authorizes GSIS to verify their civil status with relevant government agencies.

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    Affidavit of Surviving Spouse

    Uploaded by

    Kelee
    1K views1 page
    The affidavit is from a surviving spouse applying for survivorship benefits from GSIS. It states that the affiant is the widow/widower of a deceased GSIS member/retiree. The affiant declares they have not remarried or cohabited since their spouse's death. They acknowledge benefits will terminate if they remarry or cohabit. The affiant authorizes GSIS to verify their civil status with relevant government agencies.

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    Affidavit of Surviving Spouse

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    The affidavit is from a surviving spouse applying for survivorship benefits from GSIS. It states that the affiant is the widow/widower of a deceased GSIS member/retiree. The affiant declares they have not remarried or cohabited since their spouse's death. They acknowledge benefits will terminate if they remarry or cohabit. The affiant authorizes GSIS to verify their civil status with relevant government agencies.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    1K views1 page

    Affidavit of Surviving Spouse

    Uploaded by

    Kelee
    The affidavit is from a surviving spouse applying for survivorship benefits from GSIS. It states that the affiant is the widow/widower of a deceased GSIS member/retiree. The affiant declares they have not remarried or cohabited since their spouse's death. They acknowledge benefits will terminate if they remarry or cohabit. The affiant authorizes GSIS to verify their civil status with relevant government agencies.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    AFFIDAVIT OF SURVIVING SPOUSE

    I, ____________________, Filipino, of legal age, widow/widower, with address at


    ____________________ and the following contact number ____________________, after
    having sworn in accordance with law, hereby depose and state:

    I am a widow/widower of ____________________ who was a GSIS member/retiree


    who died on ____________________ at ____________________;

    I hereby declare that, since the death of my spouse, I have not remarried, cohabited
    with another person, or otherwise engaged in a common-law relationship. I acknowledge that,
    if granted, my entitlement to survivorship benefit from the GSIS 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 GSIS,
    without 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 declaration I made above, I hereby authorize the
    GSIS to secure information regarding my civil status from the National Statistics Office (NSO) 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 application for survivorship benefit with the GSIS under Republic Act No. 8291 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

    SUBSCRIBED AND SWORN to before me this ______ day ________________ 20 ____, in


    the City of ___________,Philippines, affiant exhibiting to me his/her exhibited to me his/her
    Government issued ID No._____________ issued at__________ on ____________ as Component
    Evidence of Identity (CEI).

    Doc. No. : ________________


    Page No. : ________________
    Book No. : ________________
    Series of : ________________ NOTARY PUBLIC

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