SAMPLE

Affidavit of Self Adjudication

REPUBLIC OF THE PHILIPPINES )

PASIG CITY )S.S.

AFFIDAVIT OF SELF- ADJUDICATION

I, JOSE CRUZ, Filipino, of legal age, single, and a resident of 90 Perez

Street, Barangay San Antonio, Pasig 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 JOHNNY CRUZ being his only biological
son;

2. The late JOHNNY CRUZ passed away on January 27, 2017 and died
without any last will and testament;

3. At the time of death my father had no debts, liabilities or obligations to

any persons, agency or institution;

4. The only property left by my late father is a land with improvement,

located at 91 PEREZ Street, Barangay San Antonio Pasig City, hereto attached
as Annex A;

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
JOHNNY CRUZ, as well as for the release of any other claim or benefit in
relation to his 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 30th day of January,
2017 at Pasig City, Philippines.

JOSE CRUZ
Affiant

SUBSCRIBED AND SWORN TO before me this 31 st day of January 2017,

affiant exhibiting to me her Passport No. EA023946, issued by the
Department of Foreign Affairs in Manila on 13 March 2016, at the place
before mentioned.

__________________________
Notary Public
Commission (Serial) No.
14679
__________________________
Until 31 December 2019
Roll of Attorneys No.
45285
IBP No. 65432/1-06-14/San
Antonio
PTR No. H-490789/1-06-14/San
Antonio
Doc. No. _____
Page No. _____
Book No. _____
Series of 2017.