Affidavit of Undertaking for PWA

COA affidavit of undertaking for Personnel Welfare Assistance if terminal leave is not sufficient to cover loans

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) S.S.


I, __________________, of legal age, Filipino, married/single and a resident of
____________________________, after having been duly sworn to in accordance with law,
hereby voluntarily depose and say:
1. That I have retired from the government service effective _____________.
2. That I have applied for retirement benefits effective _______________.
3. That I have outstanding financial accountability in Personnel Welfare and
Assistance (PWA).
4. That I hereby commit to pay my financial accountability to PWA from the
proceeds of my GSIS Retirement benefits.
5. That I am authorizing Government Service Insurance System (GSIS) to remit to
PWA the amount of ____________which represents my financial accountability
in the said institution.
6. That I am executing this affidavit to attest to all the above facts.
IN WITNESS HEREOF, I have hereunto signed my name below this _________
day of _____________,20______ at Quezon City.


SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of _________
___________,20 ______, affiant exhibited to me his/her Government issued ID
No._________________ issued at __________ on ____________,20 __________.
Doc. No. ________
Page No. ________
Book No. ________
Series of ________