(Declaration of Heirship / Self-Adjudication of Estate of Deceased Person)
REPUBLIC OF THE PHILIPPINES) 
Province of Benguet)  S.S. 
City/Municipality of Baguio) 
x - - - - - - - - - - - - - - - - - - - - - - - x  
AFFIDAVIT  
  I, Samantha Co, Filipino, of legal age, single , and a resident of 7 Bokawkan Road, Baguo City, 
Philippines, after being sworn in accordance with law, depose and state:  
1.  That  I  am  the  only  child  and  sole  heir  of  Peter  Co  who  died  intestate  on  January  1, 
2013 at _____________;  
2.  That  said  deceased  left  a  certain  parcel  of  land  covered  by  Transfer  Certificate  of 
Title No. 12223 and more particularly described as follows:  
(Technical Description of Property)  
3.  That said deceased left no debts, nor any Last Will and Testament;  
4.  That pursuant to Sec. 1 of Rule 74 of the Revised Rules of Court of the Philippines, I 
hereby  adjudicate  unto  myself  the  above-described  parcel  of  land,  and  the 
improvements found and standing thereon, and I hereby request the Register of Deeds 
to issue a new Transfer Certificate of Title in my name;  
5.  That  the  above-described  parcel  of  land  does  not  come  under  the  operation  of  the 
Comprehensive Agrarian Reform Program.  
  IN  WITNESS  WHEREOF,  I  have  hereunto  set  my  hand  this  _____________  in 
_____________, Philippines.   
                  AFFIANT    
SUBSCRIBED  AND SWORN  to before  me,  this  _____________,  by  the  Affiant  who is 
personally  known  to  me  (or  whom  I  have  identified  through  competent  evidence  of  identity)  and 
who  exhibited  his/her  Community  Tax  Certificate  No.  _____________  issued  at  _____________ 
on _____________.   
NOTARY PUBLIC    
Doc. No. ______; 
Page No. ______; 
Book No.______; 
Series of 20____.    
Affidavit of Self Adjudication 
REPUBLIC  OF  THE  PHILIPPINES) 
CITY OF CEBU...........................)S.S. 
AFFIDAVIT OF SELF- ADJUDICATION  
     I,         (name)            , Filipino, of legal age, (single/married), and a resident of               (address) 
             ,  Cebu  City,  Philippines  after  having  been  duly  sworn  to  in  accordance  with  law,  do  hereby 
depose and state, THAT:  
               1.  I  am  the  sole  heir  of  the  late                     (name  of  decedent)                      being  his/her  only 
biological son/daughter;  
         2. The late                     (name of decedent)               passed away on       (date of death)           
    and died without any last will and testament;  
           3. At the time of death my father/mother had no debts, liabilities or obligations to any persons, 
agency or institution;  
          4. The only property left by my late mother is (name and description of the property);  
         5. As sole heir of the herein decedent, I hereby adjudicate the abovementioned property solely 
for and in my name as well as any and all liabilities arising from the said property;  
       6. 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              (name of decedent)                   , as well as 
for  the  release  of  any  other  claim  or  benefit  in  relation  to  his/her  death  before  any 
government/private  office  and  banking  institution  and  for  any  other  legal  purpose  this  may  best 
serve.  
             IN  WITNESS  WHEREOF,  I  hereby  set  my  hands  this                (date)                      at  Cebu  City, 
Philippines.  
   (name of affiant)    
Affiant  
                  SUBSCRIBED  AND  SWORN  to  before  me  this                    (date)                      at  Cebu  City, 
Philippines.  Affiant  exhibited  to  me  his                       (I.D.  and  I.D.  No.)                     issued 
on _________________ at ______________ as his competent evidence of identity.  
Doc. No.______; 
Page No.______;                                                                     (NOTARY PUBLIC) 
Book No._____; 
Series of 20____.