Pag Ibig Affidavits

HQP-PFF-032
(V03,08/2017)
WAIVER OF RIGHTS
We, PABLO W. OFO-OB and JORDAN B. OFO-OB of legal age, widow/single,

Filipino, resident of 130 Greenwater Village, Baguio City, state that:
1. On October 9, 2017 Mrs. MARIE B. OFO-OB passed away;
2. The deceased was a member of the Home Development Mutual Fund (HDMF);
3. We are the heir of the deceased being her spouse (PABLO W. OFO-OB) and
child (JORDAN B. OFOOB);
4. We hereby waive in favor of ANNIELYN B. OFO-OB all rights and interest we may
have over the provident benefits due the deceased from the HDMF;
5. We hereby release and discharge the HDMF from any and all liability in
connection with the aforementioned waiver and release of the provident benefits in
favor of the above named person;
6. We are executing this affidavit to attest to the truth of the foregoing facts and
statements.
I further sayeth not.
PABLO W. OFO-OB JORDAN B. OFOOB ANNIELYN B. OFO-OB

Affiant Affiant Affiant
Witnesses:
_________________________ __________________________
Printed Name/Signature Printed Name/Signature
SUBSCRIBED AND SWORN to before me in the ___________________ this

_______ day of ________________, __________ by _____________________, who has
satisfactorily proven to me his/her identity through his/her
______________________________ valid until ________________________, that he/she
is the same person who personally signed before me the foregoing Waiver of Rights and
acknowledged that he/she executed the same.
NOTARY PUBLIC
Doc. No. ____________;
Page No. ____________;
Book No. ____________;
Series of 2021.
HQP-PFF-030
(V04, 08/2018)
PROOF OF SURVIVING LEGAL HEIRS
1. Name of deceased in full MARIE BELUKEN OFO-OB

2. Residence at time of death (complete address)
130 Greenwater Village, Baguio City
3. Name of Employer and address
City General Services Office, Baguio City
Position or assignment held at the time of death Laborer II
4. (a) Date and place of deceased’s birth May 22, 1967; TUBA, BENGUET
(Date) (Place)
(b) From what source was date of birth obtained
5. (a) Date and place of death October 9, 2017; Zigzag, Camp &, Baguio City
(Date) (Place)
(b) Cause of death Myocardial Infarction
6. In what capacity, or by what title, do you claim the Home Development Mutual Fund
(Pag-IBIG Fund) benefits of the deceased?
Provident benefits claim/ insurance claim
7. State whether the deceased has a last will and testament passed upon by a court and
a regular administrator of the deceased’s estate appointed by the court.
none
8. Give the names and addresses of the Surviving Heirs of deceased as of the date of
his/her death in the following order; (If any of them are under age of majority or
legally incompetent, state also the names of their guardian, if they are under
guardianship)
(a) Widow/Widower Pablo w. Ofo-ob
(b) Children (Include all children whether they are legitimate, legally adopted,
acknowledged natural or illegitimate. Attach their birth or Baptismal Certificates
or adoption papers).
Status (legitimate, legally
Name of Children adopted, acknowledged natural Date of Birth
or illegitimate)
1. ANNIELYN B. OFO-OB Legitimate 9/27/1990
2. JORDAN B. OFOOB Legitimate 9/12/1992
3. _
4. _
5. _
6. _
7. _
8. _
9. _
10. _
(c) Name of Parents State whether still living or

already deceased Date of Birth
ARCADIO L. BELOKEN Deceased
PAULINA B. BELOKEN Deceased 01-20-1942
(d) Paternal and maternal grandparents in the absence of persons called for in items
(b), and (c) above.
HQP-PFF-030
(V04, 08/2018)
(e) Brothers and sisters in the absence of persons called for in items (b), (c) and (d)
above. (Use another sheet if necessary)
Name of Guardian of
Brother/Sister Age Address Minors
1.
2.
3.
(f) Children of deceased brother/s and sister/s. (State age, address and guardian of
minors). This is required only in the absence of items (b), (c) and (d) above.
(g) Other relatives. (State relationship to deceased)
The undersigned hereby make/s claim to the Pag-IBIG Fund

Provident Benefits Claim/Insurance Claim of the deceased ____________________
and declare, confirm, affirm and agree that the written statements and affidavits and all
other papers called for the instructions hereon shall constitute declaration, confirmation
and affirmation and they are hereby made a part of this Proof of Surviving Legal Heirs
and further declare, confirm, affirm and agree that the furnishing of this form or any
other forms supplemented thereto, to said Pag-IBIG Fund shall not constitute nor be
considered an admission by the Pag-IBIG Fund that the deceased is entitled to the
Provident Benefits Claim/Insurance Claim under PD 1530 (As amended by Executive
Order Nos. 527 and 538), PD 1752 (As amended by Executive Order Nos. 35 and 90,
and Republic Act No. 7742), and RA 9679; nor a waiver of any of its right or defenses.
CLAIMANT CLAIMANT CLAIMANT
ID No. ID No. _ ID No.
Valid until Valid until Valid until
With my marital consent:
SPOUSE SPOUSE SPOUSE
SIGNED IN THE PRESENCE OF:

HQP-PFF-030
(V04, 08/2018)
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )S.S.

PROVINCE/CITY OF ______________)
BEFORE ME, a Notary Public for and in the ____________________________,

Province of ________________________, this _____ day of ____________, 20_____,
personally appeared the above-named person/s, who has satisfactorily proven to me
his/her/their identity through his/her/their identifying documents written below
his/her/their name and signature, that they are the same person/s who executed and
voluntarily signed the foregoing Proof of Legal Heirs, duly signed by his/her/their
instrumental witnesses at the spaces herein provided which he/she/they acknowledged
to me as his/her/their free and voluntary act and deed.
The foregoing instrument relates to a Proof of Surviving of Legal Heirs consisting

of ________ (___) pages including the page on which this Acknowledgment is written,
has been signed on the left margin of each and every page by the parties and the
witnesses.
WITNESS MY HAND AND NOTARIAL SEAL, this ______ day of

_____________, 20_____, in the _____________________________, Province of
____________________.
NOTARY PUBLIC
Doc. No. ____________;

Page No. ____________;
Book No. ____________;
Series of ____________.

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HQP-PFF-032

We, PABLO W. OFO-OB and JORDAN B. OFO-OB of legal age, widow/single,

I further sayeth not.

PABLO W. OFO-OB JORDAN B. OFOOB ANNIELYN B. OFO-OB

SUBSCRIBED AND SWORN to before me in the ___________________ this

PROOF OF SURVIVING LEGAL HEIRS

1. Name of deceased in full MARIE BELUKEN OFO-OB

(c) Name of Parents State whether still living or

PAULINA B. BELOKEN Deceased 01-20-1942

(g) Other relatives. (State relationship to deceased)

The undersigned hereby make/s claim to the Pag-IBIG Fund

CLAIMANT CLAIMANT CLAIMANT

ID No. ID No. _ ID No.

Valid until Valid until Valid until

With my marital consent:

SPOUSE SPOUSE SPOUSE

SIGNED IN THE PRESENCE OF:

REPUBLIC OF THE PHILIPPINES )S.S.

BEFORE ME, a Notary Public for and in the ____________________________,

The foregoing instrument relates to a Proof of Surviving of Legal Heirs consisting

WITNESS MY HAND AND NOTARIAL SEAL, this ______ day of

Doc. No. ____________;

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