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Affidavit of Claimant

Ramil Juablar Rodriguez executed an affidavit to claim insurance benefits from St. Peter's Life Insurance Plan for the death of his late wife, Carmenchu L. Rodriguez. Ramil was the spouse of Carmenchu, who died on July 9, 2017 in Ormoc City, Leyte. Carmenchu was a member of St. Peter's and had designated Ramil and their two minor children, Athena and Aldrich, as beneficiaries. As the children's legal guardian, Ramil will process, fill out, claim, and receive the insurance benefits on their behalf.

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8K views

Affidavit of Claimant

Ramil Juablar Rodriguez executed an affidavit to claim insurance benefits from St. Peter's Life Insurance Plan for the death of his late wife, Carmenchu L. Rodriguez. Ramil was the spouse of Carmenchu, who died on July 9, 2017 in Ormoc City, Leyte. Carmenchu was a member of St. Peter's and had designated Ramil and their two minor children, Athena and Aldrich, as beneficiaries. As the children's legal guardian, Ramil will process, fill out, claim, and receive the insurance benefits on their behalf.

Uploaded by

chelissamaerojas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines )

Province of Leyte ) S.S.


Municipality of Villaba )
x----------------------------------x

AFFIDAVIT
I, RAMIL JUABLAR RODRIGUEZ, of legal age, Filipino, widow and a resident of
Panganiban St., Poblacion del Norte, Villaba, Leyte, Philippines, after having been duly sworn to
in accordance with law, do hereby depose and state that:

1. I am the spouse of the late CARMENCHU L. RODRIGUEZ who died on July 9, 2017 in
OSPA, Ormoc City, Leyte. A copy of our Marriage Certificate is herein attached as Annex A.

2. My deceased wife, CARMENCHU L. RODRIGUEZ, was a member of St. Peters Life


Insurance Plan, where she made myself and our two children namely: ATHENA MAY L.
RODRIGUEZ, 12 years old and ALDRICH L. RODRIGUEZ, 11 years old, the beneficiaries
thereof.

3. Because our children-beneficiaries are all minors, I will be the one to process, fill-up, claim
and receive their insurance benefits from St. Peter, Palompon Branch, Palompon, Leyte.

4. I execute this affidavit to certify and attest to the truth of the foregoing facts and to process
our claim with the St. Peters Life Insurance Plan as beneficiaries of my late wife, CARMENCHU
L. RODRIGUEZ.

5. This Affidavit is executed for whatever legal purpose/s that it may serve.

IN WITNESS WHEREOF, I have set my hand this 26th day of July, 2017 at Villaba,
Leyte.

RAMIL JUABLAR RODRIGUEZ


Affiant
Identification Card No. ______________
Issued On: ______________
Issued At: ______________

SUBSCRIBED AND SWORN to before me, this 26th day of July, 2017 at Villaba, Leyte,
by the Affiant who is personally known to me (or whom I have identified through competent evidence
of identity) and who exhibited his Identification Card as indicated above.

.
NOTARY PUBLIC

Doc. No. ______;


Page No. ______;
Book No.______;
Series of 2017.

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