Republic of the Philippines ]

City of Tagbilaran ] S. S.

AFFIDAVIT OF HEIRSHIP WITH SIMULTANEOUS WAIVER

WE, ISIDRO P. BANSALE, Filipino, of legal age, widower and a resident of Tanday,
Baclayon, Bohol, Philippines, and MA. LEAH C. BANSALE, Filipino, of legal age, single and a
resident of Tanday, Baclayon, Bohol, Philippines, after being sworn in accordance with law,
depose and say:

1. That I am the husband and daughter, respectively, of the late DIONISIA CUERING
BANSALE;

2. That the late Dionisia Cuering Bansale died on April 9, 2022 at the Governor
Celestino Gallares, Memorial Hospital, Tagbilaran City, Bohol, Philippines;

3. That during her lifetime, Dionisia Cuering Bansale was a savings account holder
with Katipunan Bank located at Cogon District, Tagbilaran City, Bohol and at the
time of her death, such account contains an amount of SIX HUNDRED THIRTY-
FOUR PESOS AND FIFTY-FOUR CENTAVOS (P634.54) as of October 2023;

4. That by virtue of these presents, we hereby attest that we are the sole surviving legal
heirs of the late Dionisia Cuering Bansale, hence, as such, we are entitled to all the
benefits and/or claims may be due to Dionisia Cuering Bansale;

5. That, I, MA. LEAH C. BANSALE, by virtue of these presents, hereby voluntarily

WAIVE, RELINQUISH and QUITCLAIM all my rights, interests and participation
to claim any amount deposited with Katipunan Bank, in favor of my father, ISIDRO
P. BANSALE, Filipino, of legal age, widower and a resident of Tanday, Baclayon,
Bohol, Philippines;

6. That, further, I, MA. LEAH C. BANSALE, execute this affidavit voluntarily to

signify my intention to waive, relinquish and quitclaim all my rights,
interests and participation to claim any amount in the savings account of
my late mother, DIONISIA CUERING BANSALE from Katipunan Bank in
favor of my Father, ISIDRO BANSALE;

7. That we execute this affidavit voluntarily to attest to the truth of the foregoing
statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, we hereunto set our hands this 12 th day of October 2023 at
Tagbilaran City, Bohol, Philippines.

ISIDRO P. BANSALE MA. LEAH C. BANSALE

Affiant Affiant
ID CRN 0111-3978167-1 3798-6316-5781-2958
Issued by SSS Issued by PSA

SUBSCRIBED AND SWORN to before me this 12th day of October 2023 at Tagbilaran
City, Bohol, Philippines.