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    Affidavit of Surviving Spouse

    Uploaded by

    Joemar Caluna
    This affidavit was sworn by a surviving spouse applying for survivorship benefits from the Government Service Insurance System (GSIS) after the death of their spouse who was a GSIS member or retiree. The surviving spouse declares that they have not remarried or entered into a new relationship since the death of their spouse. They acknowledge that entering a new relationship would terminate their entitlement to survivorship benefits from GSIS. The surviving spouse authorizes GSIS to verify their civil status with relevant government agencies. The affidavit is submitted to attest to the truth of the statements in support of the application for survivorship benefits under Republic Act 8291.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Affidavit of Surviving Spouse

    Uploaded by

    Joemar Caluna
    63 views1 page
    This affidavit was sworn by a surviving spouse applying for survivorship benefits from the Government Service Insurance System (GSIS) after the death of their spouse who was a GSIS member or retiree. The surviving spouse declares that they have not remarried or entered into a new relationship since the death of their spouse. They acknowledge that entering a new relationship would terminate their entitlement to survivorship benefits from GSIS. The surviving spouse authorizes GSIS to verify their civil status with relevant government agencies. The affidavit is submitted to attest to the truth of the statements in support of the application for survivorship benefits under Republic Act 8291.

    Original Title

    AFFIDAVIT OF SURVIVING SPOUSE

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    This affidavit was sworn by a surviving spouse applying for survivorship benefits from the Government Service Insurance System (GSIS) after the death of their spouse who was a GSIS member or retiree. The surviving spouse declares that they have not remarried or entered into a new relationship since the death of their spouse. They acknowledge that entering a new relationship would terminate their entitlement to survivorship benefits from GSIS. The surviving spouse authorizes GSIS to verify their civil status with relevant government agencies. The affidavit is submitted to attest to the truth of the statements in support of the application for survivorship benefits under Republic Act 8291.

    Copyright:

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

    Affidavit of Surviving Spouse

    Uploaded by

    Joemar Caluna
    This affidavit was sworn by a surviving spouse applying for survivorship benefits from the Government Service Insurance System (GSIS) after the death of their spouse who was a GSIS member or retiree. The surviving spouse declares that they have not remarried or entered into a new relationship since the death of their spouse. They acknowledge that entering a new relationship would terminate their entitlement to survivorship benefits from GSIS. The surviving spouse authorizes GSIS to verify their civil status with relevant government agencies. The affidavit is submitted to attest to the truth of the statements in support of the application for survivorship benefits under Republic Act 8291.

    Copyright:

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

    Republic 

    of the Philippines )
    Province of Palawan )S.S.
    City of Puerto Princesa )

    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 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 2022.

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