Felix D. De La Cruz Jr. affirms under oath that:
1) He was the common-law spouse of Amy Francisco Naz for 3 years until her death on February 1, 2019 in Santa Cruz, Laguna.
2) Amy Francisco Naz had a Blue Card/Health Card with number 00000275508 and Felix will process her benefits as her common-law spouse.
3) Amy Francisco Naz had never been married and remained single as evidenced by her Certificate of No Marriage.
Felix D. De La Cruz Jr. affirms under oath that:
1) He was the common-law spouse of Amy Francisco Naz for 3 years until her death on February 1, 2019 in Santa Cruz, Laguna.
2) Amy Francisco Naz had a Blue Card/Health Card with number 00000275508 and Felix will process her benefits as her common-law spouse.
3) Amy Francisco Naz had never been married and remained single as evidenced by her Certificate of No Marriage.
Felix D. De La Cruz Jr. affirms under oath that:
1) He was the common-law spouse of Amy Francisco Naz for 3 years until her death on February 1, 2019 in Santa Cruz, Laguna.
2) Amy Francisco Naz had a Blue Card/Health Card with number 00000275508 and Felix will process her benefits as her common-law spouse.
3) Amy Francisco Naz had never been married and remained single as evidenced by her Certificate of No Marriage.
Felix D. De La Cruz Jr. affirms under oath that:
1) He was the common-law spouse of Amy Francisco Naz for 3 years until her death on February 1, 2019 in Santa Cruz, Laguna.
2) Amy Francisco Naz had a Blue Card/Health Card with number 00000275508 and Felix will process her benefits as her common-law spouse.
3) Amy Francisco Naz had never been married and remained single as evidenced by her Certificate of No Marriage.
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REPUBLIC OF THE PHILIPPINES )
PROVINCE OF LAGUNA )S.S.
MUNICIPALITY OF STA. CRUZ )
SWORN AFFIDAVIT
I, FELIX D. DE LA CRUZ JR., Filipino, of legal age, and resident of Barangay
Longos, Kalayaan, Laguna, after having been sworn to in accordance with the law do hereby depose and state:
1. That I am the common-law spouse of AMY FRANCISCO NAZ having
cohabiting with her for three (3) years;
2. That my common-law-spouse AMY FRANCISCO NAZ died on
February 1, 2019 at Santa Cruz, Laguna;
3. That my common-law spouse AMY FRANCISCO NAZ had a Blue
Card/Health Card with No. 00000275508 and I will be the one processing her benefits considering I am his common-law spouse;
4. That my common-law spouse has never been married and remained
single as evidenced by her Certificate of No Marriage (CENOMAR) attached as Annex A;
5. That I am exhibiting this Affidavit to attest to the truthfulness of
foregoing facts under penalty of law;
6. That I am executing this Affidavit for whatever legal purpose it may
serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 15 th day of
February 2019 at Santa Cruz, Laguna.
FELIX D. DE LA CRUZ JR Affiant
SUBSCRIBED AND SWORN to before me this 15th day of February 2019 at
Santa Cruz, Laguna, affiant exhibiting his Driver’s license with N02-08-014953 as proof of his identity. Doc. No. ____ Page No. ____ Book No. ___ Series of 2019.
