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REPUBLIC OF THE PHILIPPINES
[Province/City/Municipality]) S.S.
AFFIDAVIT OF SELF-ADJUDICATION
I, [Full Name], of legal age, [civil status], [nationality], and presently residing at [Complete Address], after having been duly sworn to in accordance with law, depose and state:
That I am the sole and only heir of the late [Full Name of Deceased], who passed away on [Date of Death] in [Place of Death], as evidenced by the attached Death Certificate;
That the deceased left behind certain property/properties, which are described as follows:
Type of Property: [e.g., Real Estate, Bank Account, Vehicle, Business, etc.]
Description: [Provide details, such as Title Number, Lot Number, Tax Declaration Number, Bank Account Number, etc.]
Location (if real estate): [Complete Address of Property]
That the deceased died without leaving a last will and testament, and that no other person has any lawful claim or share in the estate of the deceased, except me;
That as the sole surviving heir, I hereby adjudicate unto myself the above-mentioned property/properties by virtue of Section 1, Rule 74 of the Rules of Court of the Philippines, which allows self-adjudication of estates when the heir is the sole claimant;
That to the best of my knowledge, no debts or obligations remain unpaid by the deceased, and I assume full responsibility for any claims or obligations, if any; and
That I am executing this affidavit for the purpose of settling the estate of the deceased, updating legal records, effecting the transfer of ownership, and for any other legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of [month], [year], at [place of execution].
[Full Name]
Affiant
SUBSCRIBED AND SWORN TO before me in the City/Municipality of [location], this ___ day of [month], [year], by affiant who has satisfactorily proven his/her identity through [Government ID type and number], issued on [date] and expiring on [date], that he/she is the same person who personally signed before me the foregoing Affidavit of Loss and acknowledged that he/she executed the same.
NOTARY PUBLIC
Doc No. ____;
Page No.____;
Book No. ___;
Series of [YEAR].