REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF ____________)
PROVINCE OF ________________) S.S.

AFFIDAVIT
I__________________________________, Filipino Citizen and a resident of Kayrilaw Nasugbu, Batangas
Philippines, after having been sworn to in accordance with law depose and say:

1. That my _____________________________is the real owner of land consisting of

___________________________________more or less located in
__________________________ Philippines more particularly described in TAX DECLARATION
NO__________________ with Lot No. ____________________D marked here as “Annex A”;

2. That I am the sole legitimate successor of __________________, who died in

________________________ on _______________ marked here as “Annex B”;

3. However, _________________________ was listed in the survey as a property claimant despite

the fact that he did not have any documentation to support his claim;

4. I am executing this affidavit of cancellation to attest to the truthfulness of the foregoing and for
all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my hand this ____th day of __________, ___________
at _______________________________________.

___________________
Heir
SENIOR ID: B18-1389

ACKNOWLEDEGEMENT

SUBSCRIBED AND SWORN to before me in the ___________________ this _____day of ________by

______________________personally known to me, who is the same person who personally signed
before me the foregoing affidavit and acknowledge that she was executed the same.

Notary Public

Doc. No. _____ ;

Page No. _____ ;
Book No. _____ ;
Series of 2022.