AFFIDAVIT OF LEGAL HEIRS

With Waiver of Rights in Favor of Assignee

We WIFE , and name of children, Filipinos, all of legal age, and with
address ________________________(address)after being duly sworn in
accordance with law, hereby depose and state, that:

1. We are the legal heirs of __________________(deceased depositor) who

died on _______________ (Date of death) being her mother and father,
respectively:

2. During her lifetime, said ___________________( name of deceased

depositor) has left a certain personal property in the form of savings account
deposit with Country Builders Bank, Inc., Sta. Rosa Branch and covered by
Savings Account No. ______________________.

3. We are executing this affidavit for purposes of withdrawing said savings

deposit being the compulsory heirs of the deceased;

4. We,___________________( wife) and ____________________name of

children) hereby waive our rights and interest over the said deposit and
assign the same in favor of ________________( wife).

IN WITNESS WHEREOF, we have hereunto set our hands this ____ day of
__________________, 20___ at __________________________.

____________________________ _____________________________

____________________________ _____________________________

____________________________ _____________________________

____________________________ _____________________________

SUBSCRIBED AND SWORN to before me this _____ day of

__________________, 20____ at __________________, ___________________,
affiants having exhibited to me their Government Issued ID as indicated below.

Name Government Issued ID Place & Date of Issue

____________________ __________________ ___________________

___________________ ___________________ ___________________

___________________ ____________________ ____________________

___________________ ____________________ ____________________

___________________ ____________________ ____________________

___________________ ____________________ ____________________

Doc. No. ______ NOTARY PUBLIC

Page No.______ Until December 31, 20___
Book No.______ PRC No.__________
Series of _____