Share

Affidavit of Undertaking for PWA Survivorship

COA affidavit of undertaking for personnel welfare and assistance if terminal leave is not sufficient to cover loans

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
______________
) S.S.

AFFIDAVIT OF UNDERTAKING FOR PERSONNEL WELFARE AND ASSISTANCE
(PWA) (Survivorship)

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 my husband (state name)/my wife (state name) has been separated from
the government service due to his/her death effective ________;
2. That I have applied
_______________;

for

GSIS

survivorship

benefits

effective

3. That my husband/my wife has an outstanding financial accountability in
Personnel Welfare and Assistance (PWA).
4. That I hereby commit to pay his/her financial accountability to PWA from the
proceeds of his/her GSIS Retirement benefits.
5. That I am authorizing Government Service Insurance System (GSIS) to remit to
PWA the amount of __________________ which represents his/her 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.

(Affiant)

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

Notary Public
 
Page of
Share