Share

Affidavit of Undertaking for PFMS Survivorship

COA affidavit of undertaking for planning, finance and management sector 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 PLANNING, FINANCE AND MANAGEMENT
SECTOR (PFMS) (Survivorship)

I, ________________________, of legal age, Filipino, 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) had been separated
government service due to his/her death effective ________;

from the

2. That I have applied for GSIS survivorship benefits effective _______________;
3. That he/she has an outstanding bill in the Accounting Office, Planning, Finance and
Management Sector (PFMS), Commission on Audit (COA);
4. That I hereby commit to pay his/her outstanding bill in the Accounting Office, Planning,
Finance and Management Sector (PFMS), Commission on Audit, from the proceeds of
his/her GSIS Retirement benefits;
5. That I am authorizing Government Service Insurance Corporation (GSIS) to remit to
Accounting Office, Planning, Finance and Management Sector (PFMS), Commission on
Audit, the amount of ______________ which represents his/her COA Bill, out of the
proceeds of his/her retirement benefits;
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 ___________.

(Affiant)

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 ________

NOTARY PUBLIC
 
Page of
Share