This document is an affidavit form that collects information about an individual's family members. It requests details such as names, dates of birth, and addresses of the individual's spouse, children, grandchildren, parents, grandparents, siblings, and collateral relatives within the fifth civil degree. The individual signs the affidavit in the presence of an authorized officer, affirming that the information provided is true.
This document is an affidavit form that collects information about an individual's family members. It requests details such as names, dates of birth, and addresses of the individual's spouse, children, grandchildren, parents, grandparents, siblings, and collateral relatives within the fifth civil degree. The individual signs the affidavit in the presence of an authorized officer, affirming that the information provided is true.
This document is an affidavit form that collects information about an individual's family members. It requests details such as names, dates of birth, and addresses of the individual's spouse, children, grandchildren, parents, grandparents, siblings, and collateral relatives within the fifth civil degree. The individual signs the affidavit in the presence of an authorized officer, affirming that the information provided is true.
This document is an affidavit form that collects information about an individual's family members. It requests details such as names, dates of birth, and addresses of the individual's spouse, children, grandchildren, parents, grandparents, siblings, and collateral relatives within the fifth civil degree. The individual signs the affidavit in the presence of an authorized officer, affirming that the information provided is true.
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JAGO Form 15 – A
AFFIDAVIT
I, _________________________________presently assigned at __________________after
having been duly sworn to in accordance with law depose and state:
1. That I am single married widower
2. That I was born on ____________________at _______________________________
3. That my relatives are the following:
HUSBAND/WIFE: (State also name of husband by previous marriage if any)
NAME DATE OF PLACE OF BIRTH ADDRESS BIRTH
CHILDREN: (All classes including legally adopted children)
NAME DATE OF PLACE OF BIRTH ADDRESS BIRTH
GRANDCHILDREN: (Enumerate only children of your deceased children, if any)
NAME DATE OF PLACE OF BIRTH ADDRESS BIRTH
PARENTS: NAME DATE OF PLACE OF BIRTH ADDRESS BIRTH
GRANDPARENTS: (Paternal and Maternal)
NAME DATE OF PLACE OF BIRTH ADDRESS BIRTH
BROTHERS & SISTERS
NAME DATE OF PLACE OF BIRTH ADDRESS BIRTH COLLATERAL RELATIVE WITHIN 5TH CIVIL DEGREE (uncles, aunts, nephew, nieces & cousins) NAME DATE OF PLACE OF BIRTH ADDRESS BIRTH
4. That my beneficiaries for purposes of MBAI benefits are the following:
NAME DATE OF PLACE OF BIRTH ADDRESS
BIRTH
5. That I am single married X am not legally separated from my
wife/husband.
AFFIANT FURTHER SAYETH NONE.
(Affiant)
SUBSCRIBED AND SWORN to before me this day of 202
at affiant exhibiting to me his/her Community Tax Certificate Nr
Issued at on
MICHAEL CHRIS D FORNOLLES
2LT PAF Unit Adjutant (Officer Authorized to Administer Oath)
