REPUBLIC OF THE PHILIPPINES)

CITY OF _________________ ) S.S.

x------------------------------------x

AFFIDAVIT SUPPLEMENTAL TO EXTRAJUDICIAL

SETTLEMENT OF ESTATE OF DECEASED PERSON
DESIGNATING ROAD LOT
I, _______________________, of legal age, married, Filipino and residing at
_______________________, after having been duly sworn to in accordance with law,
depose and state THAT:

1. I have been issued a Special Power of Attorney by _______________ to process,

transact, and follow up the estate Tax of parcel of land located at _________________
acknowledged before Notary Public _______________ dated ________ under Doc. No.
____, Page No. ___, Book No. _______, Series of 202_.

2. In the executed Extrajudicial Settlement of Estate of Deceased Person among the

heirs of ___________________ was inadvertently omitted being designated in the
Subdivision Plan as road lot;

3. As supplement to the executed Extrajudicial Settlement of the Deceased Person,

_______________ with an area of ___ square meters, is hereby designated as Road Lot
and co-owned by _______________, and _______________, as indicated in the
approved Subdivision Plan;

4. I am executing this affidavit to attest to the foregoing facts, in support of the

application for transfer of certificate of title from ________________, and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this __________, in

__________________, Philippines.

_____________________
_____________________

SUBCRIBED AND SWORN TO before me this _______________ in

______________, Philippines, affiants exhibiting to me their valid proofs of
identification.

NOTARY PUBLIC

Doc. No. __;

Page No. __;
Book No. __;
Series of 202_.