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REPUBLIC OF THE PHILIPPINES) Province of____________________) S.S.

City/Municipality of_____________) x---------------------------------------x AFFIDAVIT OF GUARDIANSHIP OF MINORS (for BANK DEPOSITS) I, ________________(name of affiant)____________, Filipino, of legal age, [single]/[married to _________(name of spouse)_________], and a resident of ___________________(address of affiant)_______________, after having been duly sworn in accordance with law, hereby depose and state: 1. That I am the [parent]/[court appointed guardian] of _________________(name of minor)___________; 2. That I am submitting a certified true copy of the Birth Certificate of the minor, (if parent) or court appointment as guardian of said minor (if judicial guardian); 3. That __________________(name of minor)___________________ maintained Time Deposit/Savings/Current Accounts No/s. with ______________ under the account name _______________________; 4. That I, on behalf of __________________(name of minor)___________________ hereby lay claim to the deposit insurance due on the account; 5. That I shall be held liable to any person, that may be prejudiced by my representations, in addition to other liabilities, civil or criminal, that may arise therefrom; hereby releasing and discharging the Philippine Deposit Insurance Corporation (PDIC) from any all further obligations in connection with this claim; 6. That I further undertake to refund PDIC the amount paid to me including interests thereon and indemnify PDIC, the bank and/or third parties for any loss or damages occasioned by such payment. 7. That I am executing this affidavit to attest to the truth of the foregoing facts. IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________ 20___ at ____________, Philippines. _________________________________ (Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for _________(City/Province)____________ this ____th day of ____________ 20___. Affiant personally came and appeared with _____________(Competent Evidence of Identity)______ issued by the _________(Government Agency)______ on ___(date)__ at ________(place)_________, bearing his photograph and signature, known to me as the same person who personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument.

Doc. No. ____ Page No. ____ Book No. ____ Series of 20__

Atty ___________________________________________ Notary Public Commission Serial No. ____________________________ Notary Public for _______(Province/City)______________ Until December 31, 20__ Office: ______________(address)____________________ Roll No. __________ IBP Lifetime Roll No. _________; __/__/__ ; _(Province)_ PTR No. _________ ; __/__/__ ; _(Province)_ MCLE Compliance Cert. No. __________; __/__/__

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