REPUBLIC OF THE PHILIPPINES)

PROVINCE OF NEGROS ORIENTAL) S.S.

MUNICIPALITY OF SIBULAN)

AFFIDAVIT OF HEIRSHIP

WE, _______________________, and ___________________________, both of

legal ages, Filipinos and residents of _____________________________, after being
duly sworn to in accordance with law, hereby depose and state that:

1. We are the surviving children/legal heirs of

_____________________________, a member of the
___________________________________ and his deceased spouse
____________________;

2. As evidence of our legal relation to the deceased, photocopies of

our birth certificates are herein attached as Annex “A” and Annex “B”;

3. Being legal heirs, we are the person authorized to claim his death
benefits from the Integrated Bar of the Philippines;

4. We are executing this affidavit to attest to the truth of the foregoing

statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, we have hereunto affixed our hands this 1st day
of October 2018 at Municipality of Sibulan, Philippines.

_____________________________ __________________________
Affiant Affiant
Driver’s License No. ____________ Driver’s License No. _________________

SUBCRIBED AND SWORN TO before me this 1st day of October 2018 in

the Municipality of Sibulan, Philippines, affiants exhibiting to me
their Competent Evidence of Identity (CEI) as indicated herein-above.