REPUBLIC OF THE PHILIPPINES)

ANGELES CITY )S.S.

AFFIDAVIT OF SELF-ADJUDICATION
I, _____________________, of legal age, Filipino, married to
_____________________ and a resident of _____________________, after
having been duly sworn in accordance with law, do hereby depose and say
that:

1. I am one of the fourteen (14) children of

_____________________who died intestate on _____________________ as
evidenced by the Death Certificate; copy of which is hereto attached and made
integral part hereof as Annex “A”.

2. The only property left by my deceased mother is a parcel of land

which is more particularly described as follows:

““___________________________________________
_________________________________________.”

3. Four (4) of my siblings namely _____________________, PRECY

have predeceased herein decedent;

4. My siblings and co-heirs _____________________ executed a

Waiver of Rights wherein they waived, transferred and conveyed all their rights
and interests over the above-described property; copy of the Waiver of Rights is
hereto attached and made integral part hereof as Annex “B”.

5. Given that all my remaining co-heirs had already waived their rights
over the above-mentioned property, it stands to reason that I am the only
standing legal heir of deceased _____________________.

6. As sole heir of the herein decedent who left no will and testament
and left no debts, I hereby adjudicate the abovementioned property solely for and
in my name as well as any and all liabilities arising from the said property.

7. I hereby execute this affidavit for the purpose of processing the

transfer of the said property in my name, the settlement of the estate of the late
_____________________, as well as for the release of any other claim or benefit
in relation to her death before any government/private office and banking
institution and for any other legal purpose this may best serve.

8. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby

adjudicate unto myself the above described real estate by means of this Affidavit
and hereby files the same with the Register of Deed of Angeles City with the
request that the said adjudication be made effective without judicial proceeding
as prescribed by the aforementioned Rules of Court.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of

March 2018 in Angeles City, Philippines.
 2

_____________________
Affiant

SUBSCRIBED AND SWORN TO before me this 22nd day of March

2018 at Angeles City, Philippines by _____________________who has
satisfactorily proven to me her identity through her __________________ and
who is the same person who signed the foregoing above her typewritten name
and acknowledged that she personally and voluntarily executed the same.

Doc. No. _______; Notary Public,

Page No. _______;
Book No. _______;
Series of 2018.

Affidavit of Self-Adjudication – Normita David Valencia