REPUBLIC OF THE PHILIPPINES )

CITY OF SAN FERNANDO )

PROVINCE OF PAMPANGA ) S.S.
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AFFIDAVIT OF GUARDIANSHIP
I, MA. TALA N. ACAMPADO, of legal age, single, Filipino citizen, and residing at Zone 6,
Sto. Nino, Abella, Naga City, after being duly sworn to, in accordance with law, do hereby depose
and say:

1. That I am the mother of Juan Paolo A. Obligacion, a minor, who is the beneficiary of
the proceeds of the PSSLAI Passbook and AFPSLAI Passbook of the late Pelito B.
Obligacion, my deceased common law spouse, as well as the GSIS/SSS Fund and
Pag-Ibig Fund benefits of the said deceased;
2. That as evidence, I attached herewith a photocopy of the Birth Certificate of Juan
Paolo Obligacion and an Affidavit Of Paternity marked as Annex “A” and Annex “B.”
3. That I am the guardian of the above-named minor;
4. That the said minor is under my care and custody;
5. That I am competent to receive on behalf of the said minor the proceeds of PSSLAI
Passbook and AFPSLAI Passbook of the deceased, as well as the latter’s benefits
under the GSIS/SSS Fund and Pag-Ibig Fund and any amount due him;
6. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual drunkard
or a habitual criminal, and have not abandoned, neglected or refused to support said
minor or caused her to commit offenses against the law.
7. That I execute this affidavit to attest the truth of the foregoing statements.

Done this _____ day of _______________________ at _______________________.

MA. TALA N. ACAMPADO

AFFIANT

SUBCRIBED AND SWORN to before me this _____day of _______________________ at

_______________________. Affiants exhibited to me their respective Identification Cards as follows:

Name of Affiant ID No Issued at

Ma. Tala N. Acampado Voter’s ID No.: 1724-0046A- Naga City, Camarines Sur
K0676MNA20000

Juan Paolo A. Obligacion School ID No.: 1819-0078 Naga City, Camarines Sur

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of _____.