Republic 

of the Philippines )
Province of Palawan )S.S.
City of Puerto Princesa )

AFFIDAVIT OF SURVIVING LEGAL HEIRS

We, ____________________, ____________________, ____________________, of

legal age, ____________________, ____________________, Filipino and resident of
________________, _______________, ________________, _________________,
Philippines, after having been duly sworn to in accordance with the law, depose, and
state that:

I, ____________________ is the surviving spouse of the

deceased___________________ who died on ________________ at
________________________.

That we, _____________________, _____________________,

_____________________, and ____________________, are the only children of
____________________ and __________________.

That we are executing this affidavit to attest to the truth and veracity of the foregoing
facts and for all legal intents and purpose that it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands ___ day of

________________, 20 ___ at ______________.

_________________________________________________

Affiant

(State birthday and relationship to the deceased)

_________________________________________________

Affiant

(State birthday and relationship to the deceased)

_________________________________________________

Affiant
 (State birthday and relationship to the deceased)

_________________________________________________

Affiant

(State birthday and relationship to the deceased)

SUBSCRIBED AND SWORN TO before me this _____ day of _________ at

________________ affiant exhibited to his/her competent evidence of identity by way of
_________________ issued on __________________ in _______________,
Philippines.

Notary Public

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of 2022;