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.

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.

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

Doc. No ________ Until Dec. 31, 20 ________

Page No. _______ PTR no. _______________

Book No. _______ Issued at ______________

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