Affidavit of Support

Here's an example of an Affidavit of Support that you can use when availing of maternity packages. This Affidavit is usually required by hospitals before they will approve the maternity packages available for mothers giving birth, depending on the latter's needs and capacity to pay.

AFFIDAVIT OF SUPPORT

                I, __________________________________(name), ____ years old, single/married and a resident of _______________________________________(address), after having been duly sworn to in accordance with law, hereby depose and say:

1.      That I am a member of Philippine Health Insurance Corporation with PHILHEALTH ID No. ___________________(write number if applicable);

2.    That I am the mother/father/sibling/partner of ____________________________(name of pregnant woman), who is currently ____years old. A copy of her Birth Certificate is hereto appended as Annex A and forms an integral part hereof;

3.       That ________________________(name of pregnant woman) is unmarried and unemployed and that  I am the one supporting her;

4.       That _________________________ is ________ months pregnant and is due to give birth on _______________ at _______(name of hospital);

5.       That _____________________ (name of pregnant woman) is one of the beneficiaries in my membership with Philippine Health Insurance Corporation;

6.       That I am executing this affidavit to attest to the veracity of the foregoing facts and for whatever purpose not contrary to law.

                IN WITNESS WHEREOF, I have hereunto set my hand this _____________ (date) at _______________________ (place).

                                                                                          ________________________

                                                                                                 Name of Affiant

                SUBSCRIBED AND SWORN TO before me this ___________________ (date), at ______________________ (place), affiant exhibiting his Philhealth ID No. _______________ as his competent evidence of identity.

                                                                                           Notary Public

Doc. No. ___;

Page No. ___;

Book No. ___;

Series of _____.