EXTRA-JUDICIAL SETTLEMENT OF ESTATE

OF __________(name of deceased)____
WITH WAIVER OF RIGHTS

KNOW ALL MEN BY THESE PRESENTS:

We, (state here the names of the heirs of deceased client, their citizenship, age,
civil status, and address), hereby depose and state: That - -

1. We are the only legal and compulsory heirs of ____(name of

deceased depositor)________________ (decedent), who is a resident of
____(residence of deceased immediately preceding his death) ________, and who
died intestate and without any will on __(date of death) ______.

2. The said decedent left no other heir(s) whether legitimate or illegitimate.

3. The said decedent left no debts nor obligation whatsoever.

4. The said decedent left an estate consisting of the following;

(state here the deposit accounts and other real/personal properties of the
deceased depositor)

WHEREFORE, pursuant to Section 1, Rule 74 of the Rules of Court, we

hereby adjudicate unto ourselves, extra judicially and in equal – undivided
shares, the said property/ies of decedent subject only to such liabilities to
creditors, heirs or other persons who may have been deprived of their
participation therein within the period provided in Section 4, Rule 74 of the Rule
Court.

Upon adjudication and settlement of the aforementioned propery/ies,

I/We __________(indicate name of all the waivors)______________, hereby
renounce and waive my/our respective rights and interest thereon in favor of
_______________________________________.

We are executing this instrument to induce the Philippine Savings Bank

(PSBank) to allow us to claim the said deposit.

For and in consideration of the release of such deposit by PSBank and/or

recognizing our rights and interest on the subject deposit, we hereby expressly
and absolutely remiss, release and forever discharge PSBank, its officers,
employees, and assigns from any and all claims, suits, actions or causes of action
which we, our successor or assigns, now have or in the future may claim to have
against PSBank in connection with the said deposit(s), and we hereby further
obligate ourselves jointly and severally to indemnify PSBank its officers,
employees, and assigns for any loss or damage which the latter may sustain in
the event that any third person or persons shall succeed in establishing right
superior to ours concerning the aforesaid deposit(s).
 2

IN WITNESS WHEREOF, we hereunto affixed our signatures at ________

____________ this ____________________________.

(state here the name of the heirs of deceased depositor)

WITNESSES:

__________________________________ _____________________________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

) S.S.

BEFORE ME, a Notary Public for and in ___________________________ on

this _________________________________________ personally came and
appeared:

NAME VALID IDS DATE & PLACE OF ISSUE

known to me and to me known to be the same person(s) who executed the

Extrajudicial Settlement of Estate with Waiver of Rights and who acknowledged
to me that the same is their free and voluntary act and deed.

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

Doc. No.___________; NOTARY PUBLIC

Page No.___________;
Book No.___________;
Series No.__________.