Professional Documents
Culture Documents
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I, CHERRY JANE BACCAY DELA CRUZ of legal age, Filipino, widow, with
residence and postal address at Block 10 Lot 49, Vista Del Rio Subdivision, NHA,
Alimannao, Peñablanca, Cagayan, after having been swear to in accordance with the
law, depose and state:
1. That I am the LEGAL BENIFICIARY/CLAIMANT of BONIFACIO GADIANO
DELA CRUZ JR, principal member of ________________________________
for the total savings/additional benefit;
2. That I am now claiming the benefits proceeds due to his untimely death;
5. That I hold myself liable if ever disallowances will occur in this claim in the
absence of concrete/complete documents from
_________________________________.
6. That I HOLD myself solely responsible for any liability, civil or criminal, or nature
that will arise in connection with the release of the benefit claims/check of
BONIFACIO GADIANO DELA CRUZ JR in my favor.
7. That I am executing this affidavit to attest to the truth of the foregoing facts and
for whatever legal purpose or intent this may duly serve.
__________________________
Affiant
REPUBLIC OF TH PHILIPPINES
PROVINCE OF ______________) S.S.
CITY/MUN. OF ______________)
__________________________
Notary Public