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Affidavit Funeral Expense Claim

This affidavit provides details about funeral expenses paid for a deceased person in order to claim social security benefits. It states that the affiant personally knew the deceased, who was a member of the Social Security System and covered by their last employer. It then lists the funeral expenses paid by the affiant for materials, services, food and miscellaneous costs, totaling an amount. The affiant signs to attest to the truth of the statements in support of their claim for SSS benefits, in lieu of official receipts for the funeral expenses.

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LiDdy Cebrero Belen
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13K views

Affidavit Funeral Expense Claim

This affidavit provides details about funeral expenses paid for a deceased person in order to claim social security benefits. It states that the affiant personally knew the deceased, who was a member of the Social Security System and covered by their last employer. It then lists the funeral expenses paid by the affiant for materials, services, food and miscellaneous costs, totaling an amount. The affiant signs to attest to the truth of the statements in support of their claim for SSS benefits, in lieu of official receipts for the funeral expenses.

Uploaded by

LiDdy Cebrero Belen
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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RET-01224 (12-2015)

REPUBLIC OF THE PHILIPPINES )S.S.


CITY OF QUEZON )

AFFIDAVIT
(Funeral Expense)

I, _____________________, legal age, single/Married, Filipino and presently residing at


_____________________ after having been duly sworn in accordance with law hereby depose and say:

1. That I personally know the fact of death of the deceased, _____(name of


deceased)________, who died at __________________, on _______________ because
he/she was my ___________________;
2. That the deceased was a member of the Social Security System with SS Number
_______________ and covered under his/her last employer ____________________ with
business address at _________________________________________;
3. That as ______________________, I actually paid his/her funeral expenses in the amount of
P___________________, broken as follows:

a. Materials for coffin/cremation P________________


b. Interment/Transportation services P ________________
c. Food and other miscellaneous expenses during the wake P_________________
d. Others (specify) P ________________
Total: P ____________________

4. That I am executing this affidavit to attest to the truth of the foregoing statements and to
support my claim for SSS benefit, in the absence/unavailability of the Official Receipts for
funeral expenses.

FURTHER, affiant sayeth none.

_______________________________
Signature over Printed Name of Affiant

SUBSCRIBED AND SWORN TO before me this _____ day 20___ at Quezon City, Philippines,
affiant having exhibited to me his/her two (2) valid Identification Cards ______________ &
____________ bearing his/her picture and signature as competent evidence of identity.

_______________________________
NOTARY PUBLIC

Doc No. _____________:


Page No. ____________:
Book No. ____________:
Series of 2016.
RET-01224 (12-2015)

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