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Republic of the Philippines )

Province of Surigao del Sur )S.S.


xxx------------------------------xxx

AFFIDAVIT OF SURVIVING LEGAL HEIRS

WE, ______________________________, _____________________________,


_______________________, ___________________________, _________________,
_______________________, ___________________________, _________________,
all of legal ages, Filipinos and residents of Poblacion, Marihatag, Surigao del Sur,
Philippines, after having been duly sworn to in accordance with the law, depose and
state that:

That WE are the only surviving children of the late Aquillo Octobre who died on
___________________________ at __________________________________.

That WE are executing this Affidavit to attest to the truth and veracity of the
foregoing fact/s and for all legal intents and purposes that it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this ___________


day of _______________________, 2017 at ________________________________.

__________________________ _____________________________
Affiant Affiant
CTC/ID No.________________dated_________ CTC/ID No. ________________dated___________

__________________________ _____________________________

Affiant Affiant
CTC/ID No.________________dated_________ CTC/ID No. ________________dated___________

__________________________ _____________________________

Affiant Affiant
CTC/ID No.________________dated_________ CTC/ID No. ________________dated___________

__________________________ _____________________________

Affiant Affiant
CTC/ID No.________________dated_________ CTC/ID No. ________________dated___________

SUBSCRIBED AND SWORN to before me this _______ day of _____________,


2017, in the City of Tandag, Surigao del Sur, Philippines, affiants exhibited to me their
CTCs/IDs indicated below their names as Competent Evidence of Identity (CEI).

Doc. No. ______


Page No. _____
Book No. _____
Series of 2017.

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