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
biological son/daughter;

(name of decedent)

2. The late
(name of decedent)
death)
and died without any last will and testament;

being his/her only

passed away on

(date of

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
Philippines.

(date)

at Cebu City,

(name of affiant)
Affiant
SUBSCRIBED AND SWORN to before me this
(date)
Philippines. Affiant exhibited to me his
(I.D. and I.D. No.)
on _________________ at ______________ as his competent evidence of identity.
Doc. No.______;
Page No.______;
Book No._____;
Series of 20____.

(NOTARY PUBLIC)

at Cebu City,
issued

EPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI

) S.S.

x-------------------------------------x

AFFIDAVIT OF SELF-ADJUDICATION
I,

MARIA

B.

DELA

CRUZ, of

legal

age,

Filipino,

single

and

resident

of

6789 WashingtonStreet, Pio del Pilar, Makati City, after having been duly sworn to in accordance with
law, depose and state:
1. That I am the only daughter of JUAN B. DELA CRUZ who died without any last will and testament on
July 20, 2013 in Makati City as evidenced by his Death Certificate issued by the City of Makati hereto
attached as Annex A and made an integral part of this Affidavit;
2. That at the time his death, my father had no debts, liabilities or obligations to any persons, agency or
institution;
3. That the only property he left is a parcel of land consisting of 60 square meters located in J.B. Roxas
Street, Makati City more particularly described in TCT No. 112233 hereto attached as Annex B and
made an integral part of this Affidavit;
4. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate unto myself the abovedescribed real estate by means of this Affidavit and hereby files the same with the Register of Deed
of Makati City with the request that the said adjudication be made effective without judicial proceeding
as prescribed by the aforementioned provision of the Rules of Court.
IN

WITNESS

WHEREOF,

have

hereunto

set my

hand this

26th

day

of September 2013 inMakati City, Metro Manila, Philippines.

MARIA B. DELA CRUZ

Affiant

SUBCRIBED AND SWORN TO before me this 26th day of September 2013 in Makati City, Metro
Manila, Philippines, affiant exhibiting to me her Philippine Passport No. 123456 issued in Manila on
January 12, 2012 and valid until January 12, 2017.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013.

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF AAA

) S.S.

MUNICIPALITY OF BBB

AFFIDAVIT OF SELF-ADJUDICATION

I, ABC, of legal age, Filipino, single and a resident of No. 123 Municipality of AAA,
Province of BBB, Philippines, after having been duly sworn in accordance with law, do
hereby depose and say:

1. That I am the only daughter of X who died intestate ini the Municipality of AAA,
Province of BBB, on April 08, 2002 as evidenced by Death Certificate issued by the
Municipality of AAA, Province of BBB, hereto attached as ANNEX A and made an
integral part of this Affidavit;

2. That the said deceased left deposit in the Rural Bank of AAA, Inc., in the amount of
P300,000;

3. That the said deceased left no debts;

4. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate unto
myself the above described real estate by means of this Affidavit and hereby files the
same with the Register of Deed of BBB with the request that the said adjudication be
made effective without judicial proceeding as prescribed by the aforementioned Rules of
Court.

IN WITNESS WHEREOF, I have set my hand this _____ day of ____________ 2011 at
Municipality of AAA, Province of BBB, Philippines.

ABC
Affiant

SUBSCRIBED AND SWORN before me this ____ day of ____________ 2011 at

Municipality of AAA, Province of BBB, Philippines.

CCC
Notary Public
Commission to expire:______
IBP No., Place, Date
PTR No., Place, Date

Doc. No.______;
Page No. _____ ;
Book No. _____ ;
Series of ______