SEARCH
Philippine Government Forms All in One Location
Tweet
Share
Affidavit of Undertaking for Terminal Leave - Survivorship
COA survivorship affidavit of undertaking for terminal leave
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
______________
) S.S.
AFFIDAVIT OF UNDERTAKING FOR TERMINAL LEAVE (Survivorship)
I, ________________________, of legal age, Filipino, ________________, and a resident
of ___________________________________________________________________________,
after having been duly sworn to in accordance with law, hereby voluntary depose and say:
1. That I am the __________________ of the late ________________________ who passed
away on ___________________ at _____________________________ and that at the
time of his/her death was presently employed in the Commission on Audit.
2. That I am applying for Terminal
___________________________________.
Leave
on
his/her
behalf
effective
3. That pre-audit of financial transaction of national government agencies, among others,
has been lifted per COA Circular 2011-002 dated July 22, 2011;
4. That should it appear in post-audit
5. there was overpayment in the money value of his/her terminal leave benefits, I am willing
to make refund of any excess amount thereon;
6. That on the other hand, it will appear in post-audit that he/she was underpaid in his/her
terminal leave benefits, it is understood that the Commission on Audit shall likewise pay
him/her the difference of the amount corresponding to the underpayment; and
7. That I am executing this affidavit to attest to all above facts.
IN WITNESS HEREOF, I have hereunto signed my name below this ____ day of
___________, __________ at ________________.
__________________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this _____ day of _______________,
_________ in ____________________________________, affiant exhibiting to me his/her
Government ID ________________ No._________________issued at _______________ on
_______________.
Doc. No.
Page No.
Book No.
Series of
_____________
_____________
_____________
_____________
NOTARY PUBLIC
