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HQP-HLF-453 Sworn Declaration of Being Affected by Calamity

Pag - Ibig sworn declaration of being affected by calamity for express home rehabilitation/reconstruction Loan

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HQP-HLF-453
SWORN DECLARATION OF BEING AFFECTED BY CALAMITY
I, _________(name of member)_____________, of legal age, ____(civil status)__,
Filipino and with permanent address at __________________________________,
hereby certify that:
1. I am a member in good standing with Pag-IBIG Fund;
2. I am applying for a home rehabilitation/reconstruction housing loan with Pag-IBIG
Fund;
3. I am a victim of _______(name or nature of calamity)____ , and my
house/residence at ________________________________________________
was among those destroyed or damaged on ___________________.
4. Due to the above-stated calamity, I have experienced the following
damages/effects in my property:
________________________________________________________________
_______________(describe damages/effects of calamity)__________________
_______________________________________________________________;
5. I am executing this Certification to attest to the truthfulness of the foregoing facts.
6. I am aware that any fraud, misrepresentation, or misstatement of any relevant
fact which attended or accompanied my aforementioned application shall be a
ground for Pag-IBIG Fund to take action against me.
___________________________________
Signature over Printed Name of Member
_______________No.______________
Date of Issue ____________________
Expiry Date ______________________

REPUBLIC OF THE PHILIPPINES )
PROVINCE/CITY OF _______________) S.S.

BEFORE ME, a Notary Public for and in the _______________________,
Province of _____________________, this ______ day of _____________, _______,
personally appeared the above-named person/s, who has satisfactorily proven to me
his/her identity through his/her identifying documents written below his/her name and
signature, that he/she is the same person who executed the foregoing statement which
he/she acknowledged before me as his/her free and voluntary act and deed.
WITNESS MY HAND AND
_____________, ______, in the
_____________________.

NOTARIAL SEAL, this ______ day of
_______________________, Province of

NOTARY PUBLIC
Doc. No. _______;
Page No. _______;
Book No. _______;
Series of _______.

(V02, 06/2016)
 
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