REPUBLIC OF THE PHILIPPINES)

DUMAGUETE CITY ) S.S.

AFFIDAVIT OF HEIRSHIP

I, Chona C. Casido, of legal age, Filipino, and resident of Salvacion, Manjuyod, Negros
Oriental, after being duly sworn to in accordance with law, do hereby depose and state THAT:

1. I am the surviving child of Guadalupe C. Cabusog who died on [Date of death] in [Place of
Death] and her deceased spouse [Name of deceased spouse];
2. That our parents were survived by the following children/heirs:

FULL NAME OF DATES OF BIRTH

CHILDREN/HEIRS

3. As evidence of our legal relation to the deceased, photocopies of our birth certificates are herein
attached;
4. I am executing this affidavit in good faith to attest to the truth that there is no other heir or heirs
except for the above-named heirs of the said deceased spouses and for whatever legal purposes
this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of February, 2019 in
Dumaguete City.

CHONA C. CASIDO
Affiant
Identification Card:
Identification Card No.:
Valid Until:

SUBSCRIBED and SWORN to before me this ____ day of February, 2019, personally appeared
Affiant who is known to me and identified by me by competent evidence of identity in accordance with
the 2004 Rules on Notarial Practice, who exhibited to me the above identification card, who executed this
foregoing Affidavit of Heirship and acknowledged that the same is her free and voluntary act and deed.
This instrument consisting of one page, including this page whereon this acknowledgement is written has
been signed by Affiant.

IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal this _____ day
of February, 2019 in Dumaguete City, Philippines.

Doc. No._____
Page No.____
Book No. ____
Series 2019.