DECLARATION OF HEIRSHIP AND DESIGNATION

OF NEXT-OF-KIN

KNOW ALL MEN BY THESE PRESENTS:

We, ______________________, widow of ____________________, of legal

age, Filipino and a resident of ____________________________ and
___________________________ who are both of legal ages, __________,
and residents of __________________________, Philippines, do hereby
declare as follows:

1. That the above-named parties are the widow and legitimate

children and the sole and compulsory heirs of the deceased
___________________ who died on _________________ at
_____________________;

2. That the decedent died intestate, without leaving any Last

Will or Testament;

3. That decedent is a member of a the Social Security System

and has a claim therein in the amount of
_________________________;

4. That we, ________________ and ________________ hereby

designate _____________________ as the next-of-kin of the
decedent to process and claim the _________________ benefits
of the decedent with ___________________;

5. That we, _______________________ and _____________________

hereby waive our rights to process and claim the said
______________ Benefits in favor of the designated next-of-kin,
______________________________ ;

6. That we hereby affirm that we have executed this instrument

out of our own free will without force, intimidation or violence
upon our person;

7. That we hereby attest to the truth of the foregoing and to

support the claim of the ____________________Benefits of the
decedent with _________________.
IN WITNESS WHEREOF, we have hereunto set our hands this
____________________ at Bacolod City, Philippines

____________________________
WIDOW

__________________________ __________________________
CHILD CHILD

SIGNED IN THE PRESENCE OF:

_______________________ _____________________
 ACKNOWLEDGEMENT
REPUBLICOFTHEPHILIPPINES)
City of Bacolod )S.S.

BEFORE ME, a Notary Public for and in the above jurisdiction, this
_______________________, personally appeared:

Name Gov’t Issued Date/Place

ID Issued

Known to me and by me known to be the same person who

executed the foregoing Declaration of Heirship and Designation of
Next-of-Kin consisting of three (3) pages including this page where
this acknowledgment is written and acknowledged to me that the
same is their own free will and voluntary act and deed.

Witness my hand and notarial seal on the date and place first
above written.

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