(Declaration of Heirship / Self-Adjudication of Estate of Deceased Person)

REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.
City/Municipality of _____________)
x-----------------------x

AFFIDAVIT

I, _____________, Filipino, of legal age, (single / married / widow), and a resident of

_____________, Philippines, after being sworn in accordance with law, depose and state:

1. That I am the only child and sole heir of _____________ who died intestate on
_____________ at _____________;

2. That said deceased left a certain parcel of land covered by Transfer Certificate of Title
No. _____________ and more particularly described as follows:

(Technical Description of Property)

3. That said deceased left no debts, nor any Last Will and Testament;

4. That pursuant to Sec. 1 of Rule 74 of the Revised Rules of Court of the Philippines, I
hereby adjudicate unto myself the above-described parcel of land, and the
improvements found and standing thereon, and I hereby request the Register of Deeds
to issue a new Transfer Certificate of Title in my name;

5. That the above-described parcel of land does not come under the operation of the
Comprehensive Agrarian Reform Program.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ in _____________,

Philippines.

AFFIANT

(JURAT)