Affidavit of Surviving Spouse
Affidavit of Surviving Spouse
Affidavit of Surviving Spouse
I hereby declare that, since the death of my spouse, I have not remarried,
cohabited with another person, or otherwise engaged in a common-law relationship. I
acknowledge that, if granted, my entitlement to survivorship benefit from the GSIS will
automatically and permanently terminate the moment that I re-marry, co-habit with any
person/engage in a common-law relationship, whether of the same or opposite sex, or,
whether or not such a relationship is still subsisting. I hereby agree unconditionally to
reimburse/return to the GSIS, without need of demand or judicial action, all survivorship
benefits I may still unduly receive after my entitlement thereto is terminated as stated
above.
Pursuant to and consistent with the declaration I made above, I hereby authorize
the GSIS to secure information regarding my civil status from the National Statistics
Office (NSO) or other relevant government offices or even private entities.
______________________________
Affiant