REPUBLIC OF THE PHILIPPINES)

IN THE CITY OF DAVAO . . . )S.S.

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AFFIDAVIT OF SELF-ADJUDICATION

I, NENITA S. PAZ, {SURVIVING SPOUSE} of legal age, Filipino, widow, and

a resident of Old Airport, Sasa, Davao City, Philippines, after having been duly sworn to
in accordance with law, do hereby depose and state:

1. That I am the only surviving heir of PRISCILO B. PAZ who died

intestate on January 2, 2020 at Davao City {copy of his death certificate
is hereto attached as Annex “A” and made an integral part hereof}, who
in his lifetime is the account holder of a Bank of Philippine Island
{Lanang Branch};

2. At the time of his death, said decedent left no will and no debt to any
person whether natural or juridical and has no other compulsory heirs;

3. It is to the best of my interest that I hereto adjudicate unto myself the

above-mentioned bank account of the late PRISCILO B. PAZ;

4. That I am executing this affidavit to attest to the veracity and truthfulness

of the foregoing statements and for all legal intents and purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____________in the City of Davao, Philippines.

NENITA S. PAZ
Surviving Spouse

SUBSCRIBED AND SWORN to before me this January 23, 2020 at the City of Davao,
affiants exhibited to me her OSCA ID with number 14618, issued on March 29, 2019, at
Davao City.

ATTY. FAITH IMEE D. ROBLE

Notary Public for Davao City
Commission Serial No. 88888
Until Dec. 31, 2020
Attorney’s Roll No. 70888
PTR No. 12345– 02/18/19 – D.C.
IBP No. 54321– 02/18/19 – D.C.
Doc. No.____ Rm. 1E, Anda Corporate Center, Anda St.,
Page No.____ Davao City, 8000, Philippines
Book No.____ Contact No.: (+63)945-445-6912
Series of 2020. E-mail Address: faithimeeroble@gmail.com

Affidavit of Self-Adjudication | 1