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, (indicate
name of all the waivors). hereby
I/We 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. _______;