(Republic of the Philippines)

C I T Y O F D I P O L O G)S.c.
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AFFIDAVIT OF SELF-ADJUDICATION

I, EPHRAIM A. HAYAG, Filipino, of legal age, married, resident of West

Poblacion, Rizal, Zamboanga del Norte, under oath hereby depose and say:

That I am the ONLY SURVIVING HEIR of the late NELMA H. GARATE, who
died intestate and without known indebtedness on July 1, 2021, at West Poblacion,
Rizal, Zamboanga del Norte;

That at the time of the death of my sister, she left some claims/benefits from the
DILG having served as a Barangay Treasurer during her lifetime;

That pursuant to the law on intestate succession, I hereby adjudicate the said
claims/benefits from the DILG unto myself.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 2 nd day of

the August, 2021, at Dipolog City, Philippines.

EPHRAIM A. HAYAG
PRC ID No. 0017021-valid until 8/2/2022
Heir/Affiant

SUBSCRIBED AND SWORN to before me this 2 nd day of August, 2021, at

Dipolog City, Philippines, affiant exhibiting his competent proof of identity described
above, and who avowed under penalty of law to the whole truth of the contents of the
document, which he executed freely and voluntarily.

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Series of 2021.