Simple Form of Extra-Judicial Settlement
Simple Form of Extra-Judicial Settlement
Simple Form of Extra-Judicial Settlement
-AND-
W I T N E S S E T H;
WHEREAS, the HEIRS are the surviving wife and the surviving legitimate
children of the deceased ________________ who died on __________________ at
_____________; copy of his Death Certificate is attached as Annex “A”;
WHEREAS to the HEIRS’ knowledge, the deceased left no will or testament, nor
any debt or unpaid obligation whatsoever to whomsoever at the time of his death.
___________________ ___________________________
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Surviving Wife-Heir/Affiant Surviving Son/Daughter-Heir/Affiant
ID No: ID No:
Issued Date: Issued Date:
Expiry Date: Expiry Date:
_________________ ____________________
Witness Witness
ACKNOWLEDGMENT
BEFORE ME, a Notary Public for and in Mandaue City, this___ day of
_______, personally appeared _______________, who has satisfactorily proven to me his
identity, that he is the same person who executed and voluntarily signed the foregoing
instrument which they acknowledge before me as his free and voluntary act and deed.
WITNESS MY HAND AND SEAL, on the date and place above mentioned.
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