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I, _____________________, of legal age, French national and currently a

resident of _____________________, with sound and disposing mind and
memory, and without having been forced, intimidated or unduly influenced by
anybody, have hereby voluntarily executed and proclaimed this instrument, as
my Last Will and Testament, in English, a language I speak and write with, and
of which I am well conversant:

1. That I am the owner of an interest bearing U.S. Dollar Time Deposit

Account with BDO Unibank, Inc. (formerly Equitable Bank) Branch ____ located at
_____________________with Account Number _____________________, with an
original principal or initial deposit value of US$_____________________and with
a current balance of US$_____________________as of _____________________.
This Time Deposit Account is being maintained as a requirement for my Special
Resident Retiree’s Visa (SRRV) with the Philippine Retirement Authority (PRA).

2. That should I die, it is my wish and desire to bequeath, grant and

devise the said Time Deposit Account Number _____________________, and all
the proceeds thereof at the time of my death, to my girlfriend
_____________________, born on _____________________;

2.1. Should _____________________die before me, or should not wish,

or should be incapacitated, to accept the said time deposit account, the
same shall be inherited by my sons _____________________ and
_____________________ in equal shares.

3. That for the purpose of rendering this Last Will and Testament
effective, I hereby name and constitute _____________________as Executor and
Administrator of this Last Will and Testament;

4. That the Executor and Administrator I hereby nominate shall be

excused from posting any bond;

5. That I hereby revoke, set aside, and annul, any other will or
testamentary disposition I have made, signed, or proclaimed in the Philippines.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________________in Angeles City, Philippines.

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WE, the undersigned witnesses, do hereby affirm that the foregoing is the
Last Will and Testament of _____________________consisting of Two pages, and
we hereby certify: That he executed the same while of sound and disposing mind
and memory; That he signed the same in our presence, at the end hereof and on
the left hand margin of each and every page, and we, at his behest, have
witnessed and signed hereunder and on the left hand margin of each and every
page, in his presence, in the presence of the Notary Public, and in the presence of
each and every one of us this _____________________at _____________________,





BEFORE ME, a Notary Public, for and in Angeles City, this

_____________________personally appeared the following:

Competent Evidence of
Name Place/Validity Date

known to me and to me known to be the same person who executed the

foregoing Last Will and Testament, which he acknowledged to me to be his own
free and voluntary act and deed and which he executed and signed in the
presence of the three (3) above-named attesting witnesses, who all signed their
names as proof of their attestation on this page before the Testator Jacques Rene
Jean Panis and in the presence of each and everyone of them, and they
acknowledged the same to be their free and voluntary act and deed.

This Last Will and Testament consists of TWO (2) pages, including the
page on which the ratification and acknowledgment are written.

WITNESS MY HAND AND SEAL this _____________________ in


Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017;