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    201 PPF

    Uploaded by

    Se'f Benitez
    1. John Mark Lacibal Artieda, a Filipino police officer, confirms in an affidavit that his sole legal beneficiary is his mother, Rogelia Lacibal Artieda. 2. He confirms his relationship to his mother by attaching original documents including his birth certificate and cenomar obtained from the Philippine Statistics Authority. 3. He acknowledges that he would be criminally and administratively liable if any of the statements or documents submitted are found to be inaccurate or false.

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    201 PPF

    Uploaded by

    Se'f Benitez
    41 views3 pages
    1. John Mark Lacibal Artieda, a Filipino police officer, confirms in an affidavit that his sole legal beneficiary is his mother, Rogelia Lacibal Artieda. 2. He confirms his relationship to his mother by attaching original documents including his birth certificate and cenomar obtained from the Philippine Statistics Authority. 3. He acknowledges that he would be criminally and administratively liable if any of the statements or documents submitted are found to be inaccurate or false.

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    1. John Mark Lacibal Artieda, a Filipino police officer, confirms in an affidavit that his sole legal beneficiary is his mother, Rogelia Lacibal Artieda. 2. He confirms his relationship to his mother by attaching original documents including his birth certificate and cenomar obtained from the Philippine Statistics Authority. 3. He acknowledges that he would be criminally and administratively liable if any of the statements or documents submitted are found to be inaccurate or false.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    41 views3 pages

    201 PPF

    Uploaded by

    Se'f Benitez
    1. John Mark Lacibal Artieda, a Filipino police officer, confirms in an affidavit that his sole legal beneficiary is his mother, Rogelia Lacibal Artieda. 2. He confirms his relationship to his mother by attaching original documents including his birth certificate and cenomar obtained from the Philippine Statistics Authority. 3. He acknowledges that he would be criminally and administratively liable if any of the statements or documents submitted are found to be inaccurate or false.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Republic of the Philippines)

    )
    ) . . .s.s

    AFFIDAVIT OF CONFIRMATION

    I, JOHN MARK LACIBAL ARTIEDA, a Filipino of legal age, a resident of MAGSAYSAY


    VILLAGE, LA PAZ, ILOILO CITY, a bonafide member of the Philippine National Police with the rank
    of Patrolman and presently assigned at RPHAU PRO6, CAMP GEN MARTIN TEOFILO B
    DELGADO after having been duly sworn to in accordance with law, do hereby depose and says that

    1. Pursuant to this affidavit, I am confirming that the following are my legal beneficiary/ies
    and/or heirs, to wit:

    NAME RELATIONSHIP BIRTHDATE


    ROGELIA LACIBAL ARTIEDA MOTHER JAN. 01, 1962

    2. My relationship with person/s whose name/s is/are listed above is/are borne out by the
    fact that I am the lawful child of the afore-mentioned parent/s as evidenced by the
    attached cenomar and birth certificate/s.

    3. That all the documents I have attached and submitted to support the updating of my
    Declared Legal Beneficiary/ies are original copies obtained from Philippine Statistics
    Authority (PSA), and

    4. I hold myself criminally and administratively liable for perjury and dishonesty should any
    statements made herein/documents submitted herewith are inaccurate or later found to
    be false and in violation of law.

    AFFIANT SAYETH NAUGHT:

    _________________________
    Affiant

    Contact No. 09053134857

    SUBSCRIBED AND SWORN to before me this _______ day of ___________________ at


    __________________________________Philippines.

    Doc. No. ___________


    Page No. ___________
    Book No. ___________
    Series No. ___________
    TABLE OF CONTENTS
    FOR SINGLE

    UNIT ENDORSEMENT------------------------------------------------- TAB “A”

    NOTARIZED AFFIDAVIT OF CONFIRMATION ----------------- TAB “B”

    ORIGINAL COPY OF PSA-ISSUED CENOMAR


    OF PNP PERSONNEL WITH OFFICIAL RECEIPT------------- TAB “C”

    ORIGINAL COPY OF PSA – ISSUED BIRTH CERTIFICATE


    OF PNP PERSONNEL WITH OFFICIAL RECEIPT ------------ TAB “D”

    ORIGINAL COPY OF PSA – ISSUED BIRTH CERTIFICATE


    OF DEPENDENTS WITH OFFICIAL RECEIPT ----------------- TAB “E”

    ORIGINAL COPY OF PSA-ISSUED MARRIAGE


    CONTRACT OF PARENTS ------------------------------------------- TAB “F”

    PHOTOCOPY OF VALID ID WITH 3 SIGNATURES AND


    2X2 PICTURE W/ NAME TAG OF DEPENDENTS
    AND PNP PERSONNEL (WHITE BACKGROUND) ------------ TAB “G”

    ORIGINAL COPY OF PSA – ISSUED DEATH


    CERTIFICATE OF DEPENDENTS WITH
    OFFICIAL RECEIPT (IF DECEASED) ----------------------------- TAB “H”
    ARTIEDA, JOHN MARK L
    PATROLMAN/PPF NO.

    201 FILE
    (PPF)
    PAT JOHN MARK L ARTIEDA
    RPHAS, PRO6
    Magsaysay Village, La Paz, Iloilo
    City
    09053134857

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