DECLARATION OF HEIRSHIP WITH EXTRA-JUDICIAL

SETTLEMENT OF ESTATE WITH WAIVER OF RIGHTS

KNOW ALL MEN BY THESE PRESENTS:

I, _________________, only son of the late ___________________, Filipino and a resident of

Bacolod City, Philippines,

WITNESSETH:

That the late _______________, Filipino, married to _______________, and resident of the City
of Bacolod, and the owner of a parcel of land known _______________ and
_______________covered by Transfer Certificate of Title No. _______________ and _______________,
respectively, situated in the Municipality of E.B. Magalona, Province of Negros Occidental,
Philippines, with all the improvements thereon and which is more particularly bounded
and described as follows:

TRANSFER CERTIFICATE OF TITLE NO. ____________

That the late_____________ died on _________________ in Bacolod City without leaving any
will nor there is any Special Proceeding filed in court to date relative to his estate.

That the decedent left as his only compulsory and qualified heir, his son,
_______________and thus, it is to the best interest of the above-named declarant who is of legal
age to partition the property left by the decedent extra judicially;

That invoking the provisions of law relative to hereditary succession, the above-
named Heir/Declarant hereby adjudicate unto himself the above-described parcel of land
as follows:

To: That I hereby affirm that I have executed the this instrument out of my own free
will without force, intimidation or violence upon my person, and that I have hereby
received my just and proper share and have no more claim or demand against each other in
connection with the adjudication of the above-described parcel of land;

That I _____________, for my part and for and in consideration of the sum of _____________

(P_____________), Philippine Currency, to me in hand paid by __________, I do hereby SELL,
TRANSFER and CONVEY unto the same all my rights, interest and participation in the above
described parcel of land, do hereby WAIVE all my rights, interest and participation in the
above-described parcel of land, in favor to Richard Segovia, share and share alike, pro
indiviso.

IN WITNESS WHEREOF, the parties have hereunto set my hands this ____ day of
_________________ at Bacolod City, Philippines.

Heir
 SIGNED IN THE PRESENCE OF:

___________________________ ___________________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

CITY OF BACOLOD ) S.S.
X--------------------------------------------X

BEFORE ME, at the City of Bacolod, Philippines, ______ day of August 2019
personally appeared the following persons with his Government Issued ID issued on
_____________________ at __________________, who is personally known to me to be the same
person who executed the foregoing instrument and acknowledged to me that they executed
the same as his own free and voluntary act and deed.

WITNESS MY HAND AND SEAL at the place and on the date first above-written.

Doc. No._____
Page No._____
Book No._____
Series of 2019.