DECLARATION OF HEIRSHIP

WE, _______________________, and ______________, all of legal age, Filipino citizens, and presently
residing at ___________________, after being duly sworn in accordance with law, do hereby voluntarily
declare the following :

1. That we are the legitimate spouse and children and the sole heirs of the late __________________
who died intestate in _____________ on _______________, as evidenced by the Death Certificate
issued by the Philippine Statistics Authority hereto attached as Annex “A”;

2. That said deceased at the time of his death left the following bank deposits under his account with
the _______________, _______________ Branch:
Savings Account No. ______________ . . . . . . . . . . . . . . .PHP_______________;
Time Deposit Acct. No. ______________ . . . . .. . . . . . . . PHP ______________;

3. That to the best knowledge and information of the parties hereto, said deceased left no debts;
4. That the parties hereto being all of legal age and with full civil capacity to
contract, hereby agree to adjudicate among themselves said money in equal shares;
5. That we are executing this statement to attest to all the above facts and for the
purpose of withdrawing said bank deposits and having it placed under the joint account of the parties.

IN WITNESS WHEREOF, We have hereunto affix our signatures below this ________________,
in _________________, Philippines.