Affidavit of Funeral Expense Template

If you are filing for SSS Funeral Benefit of your relative or helping a friend, the Affidavit of Funeral Expense is needed to enumerate expenses made in the Funeral of the diseased SSS Member. Here, we created a template you can copy or You may also download this Word File Affidavit of Funeral Expense Template, Fill in your information then print.

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REPUBLIC OF THE PHILIPPINES )                                                            : S.S.______________________)

 AFFIDAVIT OF FUNERAL EXPENSES

            I, JUANA DELA CRUZ, of legal age, married, Filipino with residence and postal address at  _____________________________________________, after being duly sworn to in accordance with law, hereby depose and state:

1.         That I know the fact of death of the deceased, ______________, who died at _________ on ______________ because _____________;

2.         That during the wake, I actually paid the following expenses to wit:

1. _____________________________ -P
2. _____________________________ -P
3. _____________________________ -P
4. _____________________________ -P
5. _____________________________ -P
6. _____________________________ -P
7. _____________________________ -P

TOTAL                                                      = P________

3.         That I am executing this affidavit to attest to the truth of  the foregoing statements and for the purpose of filing Funeral Expense Reimbursement claim from _______________________.

FURTHER,      affiant sayeth none.

                                                                         _____________________                                                                                        Affiant

            SUBSCRIBED AND SWORN TO before me this ____ day of _________ at ______________, Philippines, affiant  having exhibited to me her Residence Certificate No. ______________  issued at _____________ on _________________.

 

                                                                           ______________________

                                                                                    Notary      Public

Doc. No ________                                            Until Dec. 31, 20 ________

Page No. _______                                             PTR no. _______________

Book No. _______                                            Issued at ______________

Series of   2011