AFFIDAVIT OF INSERTION

We, xxx, of legal age, nationality, single, with postal address____________; xxx,
of legal age, nationality, single, with postal address ____________ ; and xxx, of legal age,
nationality, single, with postal address at ______________, after being duly sworn to in
accordance we law, depose and state that –

1. We are the heirs of the late __________________, resident of ________________, and

who died last ________________;

2. We executed an Extrajudicial Settlement of Estate with Waiver dated ____________ as

notarized by Atty. ____________ under Doc. No. ________, Page No. ________, Series
of _________;

3. In the said Extrajudicial Settlement of Estate with Waiver, we agreed to extra-

judicially settle the estate of the decedent, which consists of a house and lot
located at ________________ and described as Transfer Certificate of Title No.
______________ by waiving our rights over the same in favor of our sister,
____________;

4. Unfortunately, we forgot to include the paragraph below in the last part of the
Extrajudicial Settlement of Estate with Waiver, to wit:

“That we hereby affirm that we have executed the foregoing instrument

out of our own voluntary free will without force, intimidation or
violence our persons, that we have hereby received our just and proper
shares and have no claim or demand against each other.”

5. Through this Affidavit, we hereby declare under oath that “we hereby affirm that
we have executed the foregoing Extrajudicial Settlement of Estate with Waiver out of
our own voluntary free will without force, intimidation or violence our persons, that
we have hereby received our just and proper shares and have no claim or demand
against each other.”

6. We are executing this Affidavit to attest to the truth of the foregoing and for whatever
legal purpose it may serve.

Done this _______ at ___________________.

________________ ____________________

_______________

Page 1 of 2
REPUBLIC OF THE PHILIPPINES) S.S
______________________________)

SUBSCRIBED AND SWORN to before this ______ day of ___________, affiants

exhibiting to me their competent evidence of identity (CEI) as follows:

Name CEI No. Date/Place Issued

NOTARY PUBLIC

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of ______.

Page 2 of 2