Affidavit of Self Adjudication

REPUBLIC OF THE PHILIPPINES)

CITY OF CEBU...........................)S.S.

AFFIDAVIT OF SELF- ADJUDICATION

I, (name) , Filipino, of legal age, (single/married), and a

resident of (address) , Cebu City, Philippines after having
been duly sworn to in accordance with law, do hereby depose and state,
THAT:

1. I am the sole heir of the late (name of decedent)

being his/her only biological son/daughter;

2. The late (name of decedent) passed away

on (date of death) and died without any last will and
testament;

3. At the time of death my father/mother had no debts, liabilities

or obligations to any persons, agency or institution;

4. The only property left by my late mother is (name and

description of the property);

5. As sole heir of the herein decedent, I hereby adjudicate the

abovementioned property solely for and in my name as well as any and
all liabilities arising from the said property;

6. I hereby execute this affidavit for the purpose of processing the

transfer of the said property in my name, the settlement of the estate of
the late (name of decedent) , as well as for the
release of any other claim or benefit in relation to his/her death before
any government/private office and banking institution and for any other
legal purpose this may best serve.

IN WITNESS WHEREOF, I hereby set my hands this (date)

at Cebu City, Philippines.

(name of affiant)
Affiant

SUBSCRIBED AND SWORN to before me this (date)

at Cebu City, Philippines. Affiant exhibited to me his (I.D. and
I.D. No.) issued on _________________ at ______________ as his
competent evidence of identity.

Doc. No.______;
Page No.______; (NOTARY
PUBLIC)
Book No._____;
Series of 20____.