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Notary Public
Notary Public
AFFIDAVIT
I, JOSEPH B. PADUA, of legal age, married, Filipino and a resident of #4 Ilang Ilang
St., Montalban, Rizal, after having been duly sworn to in accordance with law do hereby depose
and say:
1. That I am the brother of the late GEORGE B. PADUA who died a widower on May
2, 2005 at Rizal Street, Bangued, Abra;
2. That I shouldered all the expenses for the funeral and burial services of my deceased
brother which amounted to THIRTY THOUSAND PESOS (P30,000.00), more or
less;
3. That I have executed this affidavit to attest to the truth of all the foregoing and to
satisfy the inquiry or requirements of the GOVERNMENT SERVICE
INSURANCE SYSTEM (GSIS) in support of my claim for burial benefits and for
other legal purpose it may serve.
FURTHER, AFFIANT SAYETH NAUGHT.
JOSEPH B. PADUA
Affiant
SUBSCRIBED AND SWORN to before me this 20 th day of May 2005 in Quezon City,
affiant exhibited to me his Drivers License No. A08-02-021659 which expires on 2007-06-19.
Doc. No. ________:
Page No. ________:
Book No. ________:
Series of 2005.
Notary Public
of
Social
Security
System
under
SSS
Birthdate
06-18-93
11-29-94
07-22-96
11-13-98
Age
12
10
9
6
GLORILIE S. TUMAMPIL
Affiant
SUBSCRIBED AND SWORN to before me this 24th day of May, 2005 in Quezon
City.
Doc. No.______:
Page No.______:
Book No.______:
Series of 2005.