Escolar Documentos
Profissional Documentos
Cultura Documentos
AFFIDAVIT
I, LEODIVINA M. BAUAN, married, Filipino, of legal age, with address at Pallocan, Batangas City,
having been duly sworn in accordance with law, hereby depose and state:
1. I am the owner and holder of The Manufacturers Life Insurance Company (Philippines), Inc.
Policy No. 6448285-4
3. On the dates set forth below, I delivered to Ms. Lorenza Bool, and the latter duly received from
me, the following amounts representing payment of premium(s) due on my afforested policy:
5. I am executing this affidavit to attest the truth of the foregoing and to requests The
Manufacturers Life Insurance Company (Philippines), Inc. to honor my payments, in the amounts and
on the dates set forth above, and to place my above-stated policy in force. In the event that the
foregoing are found to be false and untrue, I undertake to immediately pay any amount due and/or
comply with the reinstatement requirements, otherwise my policy(ies) shall be considered lapsed as of
its actual premium due and unpaid, without prejudice to The Manufactures Life Insurance Company
(Philippines), Inc.s right to proceed against me for such falsity.
LEODIVINA M. BAUAN
Affiant
ACKNOWLEDGEMENT
SUBSCRIBED AND SWORN TO BEFORE ME, in the City of Batangas on this __________________, the
Affiant exhibited to me his/her: