I, _________________, of legal age, single/married/widow, Filipino citizen, and presently residing at _____________________, after having been duly sworn to in accordance with law, do hereby depose and say:
1. That I am the ___(state relationship)__ and guardian of the following minor/s who has / have an interest in the _______________ of the late _________________________ payable by ________________;
Full Name of Minor/s
Date of Birth
2. That the above mentioned minor/s is/are under my care and custody;
3. That I am competent to receive in behalf of the said minor/s any amount/s due him/them; and
4. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual drunkard or a habitual criminal, and have not abandoned, neglected or refused to support said minor/s or caused him/them to commit offenses against the law.
5. That I am executing this affidavit to attest to the truth of all the foregoing statements and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________ 20____ in ____________, _____________, Philippines.