Republic of the Philippines)

Municipality of Sibulan. . . ) S. S.
X-----------------/

AFFIDAVIT OF HEIRSHIP AND UNDERTAKING

I, CHERYL B. DIONGCO, married, of legal age, Filipino, and a resident of Cangmating,

Sibulan, Negros Oriental, after having been duly sworn to in accordance with law, hereby state and
declare that:

1. I am one of the surviving heirs of the late INOCENCIO FONOLLERA, who died
intestate and left no known debts that remains unpaid, who is the one of the co-owners of a parcel of land
known as Lot No. 1145-A, containing an area of FOUR THOUSAND TWO HUNDRED FIFTY TWO
(4, 252) SQUARE METERS, more or less, situated in the Barrio of Maslog, Municipality of Sibulan,
Province of Negros Oriental and covered by Transfer Certificate of Title No. T-19763;

2. That the late INOCENCIO FONOLLERA died intestate and left no debts or obligations
due against his estate and was survived by his ten (10) children, one of them is LINAVILLA F.
FONOLLERA, who is my mother;

3. That the late LINAVILLA F. FONOLLERA died intestate and left no debts or
obligations due against her estate and was survived by her three (3) children, I am one them;

4. With the death of my parents and grandparents, I am entitled to inherit and/or succeed to
the above-described parcel of land through succession;

5. I am applying for a Building Permit and electric connection permit to the Office of the
Local Building Official for the construction of my residential building on the said lot. I further undertake
that the department/person/agency/ approving the said permit is not to be made accountable relative to its
issuance and I take full responsibility in case of any claims or complaints including the application of
building permit and electric connection permit on the abovementioned lot being one of the heirs of the
registered owners thereon;

6. I am executing this affidavit in order to establish all of the foregoing facts, and in order to
establish that I am one of the surviving heirs of the late INOCENCIO FONOLLERA, entitled to inherit
to the aforementioned parcel of land;

IN WITNESS WHEREOF, I have hereunto affixed my signature this __________________, in

Sibulan, Negros Oriental, Philippines.

CHERYL B. DIONGCO
Affiant
ID: Non-Professional Driver’s License No.
G02-12-001877 valid until 2023/07/11

SUBSCRIBED AND SWORN TO BEFORE ME, this ________________, in Sibulan, Negros

Oriental, Philippines, affiant exhibited to me proof of her identity written below her respective name and
signature.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2022.