REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ILOILO )S.S.

CITY OF ILOILO )S.S.

AFFIDAVIT OF SELF-ADJUCATION WITH QUITCLAIM

I, ZENAIDA F. FAJIMOS-HILAPAD, of legal age, married, Filipino, and

a resident of Brgy. Poblacion, Ilawod, Dumarao, Capiz, after having been duly
sworn to in accordance with law, do hereby depose and say that:

1. I am the sole surviving sibling and heir of my late sister, LETICIA F.

FAJIMOS, who died single and intestate without a will and testament,
sometime on June 20, 2020 at Brgy. Poblacion, Ilawod, Dumarao, Capiz.
Attached hereto is a copy of the Death Certificate of my deceased sister as
ANNEX “A” and made an integral part hereof;

2. At the time of her death, Leticia F. Fajimos left a personal property,

specifically, bank deposit at LANDBANK OF THE PHILIPPINES Roxas
Branch under Account No. 5166236764;

3. Being the surviving heir of Leticia F. Fajimos, I am the only person legally
entitled to inherit the money left in Account No. 5166236764, totaling to
FORTY THOUSAND NINE HUNDRED PESOS AND THIRTY CENTAVOS
(Php 40,900.30);

4. To the best of my knowledge, no other person is rightfully entitled to the

money under said account of Leticia F. Fajimos except me, being the only
surviving sibling and heir of the decedent;

5. Said deceased left no debts;

6. Pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate unto
myself the said LBP Account with account no. 5166236764 and the money
deposited in it, which represent my lawful inheritance;

7. Upon receipt of the proceeds of said savings account, I undertake to render

the Bank free and harmless against any and all claims by third parties
whatsoever;

8. Wherefore, for and inconsideration of the foregoing premises and my actual

receipt of the proceeds of said bank account, I hereby freely and voluntarily
RENOUNCE, WAIVE, QUITCLAIM, and forever RELEASE any and all claims
and/or causes of action, which I may have or hereafter have, against the
Bank, its offices and agents, over Account No. 5166236764, in manner that
is absolute and irrevocable.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____

day of _______________ 2021 at ________________________.

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 ZENAIDA F. HILAPAD
Affiant
ID No. ________________

SUBSCRIBED AND SWORN to before me, this ____________________ at

______________________, Philippines, affiant exhibiting to me her Identification
Card bearing the ID number below her name as competent proof of her identity.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2021;

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