REPUBLIC OF THE PHILIPPINES)

CITY OF DAVAO )S.S.

AFFIDAVIT OF SELF ADJUDICATION

WITH UNILATERAL DEED OF SALE

I, ____________________, of legal age, Filipino, married to ____________________, and a

resident of Davao City, Philippines, after having been sworn in accordance with law, hereby
depose and state that:

1) I am the sole and only surviving legal heir of the late spouses
____________________ and ____________________, who both died intestate on ____________________ and
____________________, respectively, at Davao City, Philippines (Copies of their respective death
certificates are hereto attached as ANNEXES “A” and “B”), without leaving any will or debt
that has not been settled up to the present;

2) The said deceased spouses, at the time of their death, left a residential house
and lot situated at ____________________, Davao City, covered by Transfer Certificate of Title
(TCT) No. ____________________, with an area of ____________________ (____) square meters, which
is more particularly described as follows:

(insert technical description)

3) At the time of the deceased spouses’ death, there is no pending case or action
filed involving the above-described property in any court or judicial tribunal in the
Philippines;

4) Pursuant to Sec. 1 Rule 74 of the Revised Rules of Court of the Philippines, I

hereby adjudicate unto myself the above described parcel of land and all the improvements
thereon, without judicial proceedings as prescribed by the aforementioned Rules of Court;

5) Furthermore, for and in consideration of the total sum of

________________________ PESOS (Php______________.00), receipt of which is hereby acknowledged
to my satisfaction, I hereby SELL, TRANSFER and CONVEY unto and in favor of
__________________________, of legal age, Filipino, married, and a resident of Davao City,
Philippines, as well as, all his successors and assigns, in a manner absolute and irrevocable,
the above-described parcel of land together with all the improvements thereon;

6) I hereby warrant the validity of the title and the peaceful possession of the
property herein sold and conveyed, and further declare that the same is free and clear of all
liens, claims, and encumbrances of any kind whatsoever;

7) I undertake and obligate myself to execute any and all documents,

instruments and deeds necessary, appropriate or required to effectuate the sale and the
provisions herein contained.

IN WITNESS WHEREOF, I have here unto set my hand this _____ day of _______________,
2017 in Davao City, Philippines.

____________________
Affiant
ID Type & No.: ____________________________

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 Signed in the presence of __________________________ & __________________________

Republic of the Philippines}

CITY OF DAVAO }S.S

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the City of Davao, Philippines, personally
appeared ____________________, whom I have identified through her competent evidence of
identity as indicated above, and who represented herself to me to be the same person who
executed the foregoing AFFIDAVIT OF SELF ADJUDICATION WITH UNILATERAL DEED OF
SALE, consisting of two (2) pages including the page on which this Acknowledgment is
written, the same having been signed by her and her witnesses on each and every page
hereof, and acknowledged and sworn to me that the same is her own free act and voluntary
deed.

WITNESS MY HAND AND SEAL this ____________________ in Davao City, Philippines.

Doc No. _____;

Page No._____;
Book No. ____;
Series of 2019.

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