HQP-PFF-028

(V03, 08/2017)

AFFIDAVIT OF GUARDIANSHIP

I, __________________________, of legal age, Filipino, single/married/widow/er

and with residence and postal address at _________________________________,
after being duly sworn to in accordance with law, depose and state that:

1. I am the _____________________ (relationship) of the minor/s named below

who has/have an interest in the Home Development Mutual Fund (Pag-IBIG
Fund) provident benefits of the late ____________________ payable by the
Pag-IBIG Fund.

NAME OF MINOR DATE OF BIRTH AGE

_________________________________ __________________ _________
_________________________________ __________________ _________
_________________________________ __________________ _________
_________________________________ __________________ _________
_________________________________ __________________ _________

2. I am the guardian of the above-named minor/s;

3. The said minor/s is/are under my care and custody;

4. I am competent to receive in behalf of the said minor/s any amount/s due

him/her/them;

5. I have not been diagnosed nor committed to a hospital or institution for

imbecile, insane, a vagrant or vicious person. I am not a habitual drunkard or
a habitual criminal, and have not abandoned, neglected or refused to support
said minor/s or caused him/her/them to commit offenses against the law; and

6. I am executing this affidavit to confirm and affirm the foregoing facts and to
prove that I am the legal guardian of the above-named minors, and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of

____________, 20___ at ___________________________.

___________________
AFFIANT

SUBSCRIBED AND SWORN to before me in the _______________________

this ____ day of ______________, _______ by _______________________, who has
satisfactorily proven to me his/her identity through his/her
______________________________, valid until ________________, that he/she is the
same person who is personally signed before me the foregoing Affidavit of
Guardianship and acknowledged that he/she executed the same.

NOTARY PUBLIC
Doc. No. ____________;
Page No. ____________;
Book No. ____________;
Series of ____________.