Sample Special Proceedings Forms
Sample Special Proceedings Forms
AFFIDAVIT OF SELF-ADJUDICATION
I, MARIA B. DELA CRUZ, of legal age, Filipino, single and a resident of 6789 Washington Street, Pio del Pilar, Makati
City, after having been duly sworn to in accordance with law, depose and state:
1. That I am the only daughter of JUAN B. DELA CRUZ who died without any last will and testament on July 20, 2013 in
Makati City as evidenced by his Death Certificate issued by the City of Makati hereto attached as Annex “A” and made
an integral part of this Affidavit;
2. That at the time his death, my father had no debts, liabilities or obligations to any persons, agency or institution;
3. That the only property he left is a parcel of land consisting of 60 square meters located in J.B. Roxas Street, Makati City
more particularly described in TCT No. 112233 hereto attached as Annex “B” and made an integral part of this Affidavit;
4. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate unto myself the above-described real estate by
means of this Affidavit and hereby files the same with the Register of Deed of Makati City with the request that the said
adjudication be made effective without judicial proceeding as prescribed by the aforementioned provision of the Rules
of Court.
IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of September 2013 in Makati City, Metro
Manila, Philippines.
SUBCRIBED AND SWORN TO before me this 26th day of September 2013 in Makati City, Metro Manila, Philippines,
affiant exhibiting to me her Philippine Passport No. 123456 issued in Manila on January 12, 2012 and valid until January
12, 2017.
This AGREEMENT made and entered into this 2nd day of October 2013 by and among:
LEILA M. SANTOS, of legal age, Filipino, single, and with residence and postal address at 1111 Santillan Street, Pio del
Pilar, Makati City;
MILA M. SANTOS-RUBIO, of legal age, Filipino, married, and with residence and postal address at 2222 J. Victor Street,
Pio del Pilar, Makati City:
JOSE M. SANTOS, of legal age, Filipino, single, and with residence and postal address at 3333 Taylo Street, Pio del Pilar,
Makati City;
WITNESSETH:
THAT we are the legitimate children and sole heirs of LUCIO T. SANTOS who died on June 25, 2013 in Makati
City; copy of his death certificate is hereto attached as Annex "A";
THAT said deceased died without any will or testament and without any outstanding debts in favor of any person or
entity;
THAT said deceased, at the time of his death, left a certain real property, situated in Makati City and more
particularly described as follows, to wit:
THAT pursuant to Section 1 of Rule 74 of the Revised Rules of Court of the Philippines, and we being all of age and
with full capacity to contract, we do hereby adjudicate unto ourselves the land described above, in equal shares.
IN WITNESSS WHEREOF, we have hereunto signed this AGREEMENT, this 2nd day of October 2013 in the City of
Makati, Philippines.
THE HEIRS OF LUCIO T. SANTOS
__________________________ _____________________________
Witness Witness
ACKNOWLEDGMENT
BEFORE ME, a Notary Public, for and in the City of Makati, this 2ndday of October 2013 personally appeared:
all known to me to be the same persons who executed the foregoing instrument and hereby acknowledged to me that
the same is their free and voluntary act and deed.
This instrument consisting of two (2) pages, including this page on which this acknowledgment is written refers to an
EXTRAJUDICIAL SETTLEMENT OF ESTATE and has been signed by the parties and their witnesses and sealed with my
notarial seal.