REPUBLIC OF THE PHILIPPINES)

:
IN THE CITY OF PAGADIAN…..)S.S
X------------------------------/

AFFIDAVIT
(Declaration of Heirship / Self-Adjudication of PHILAM LIFE
Insurance Proceeds/Benefits Accounts of Deceased Person)

I, MYLEEN T. BALAOING, Filipino, of legal age, widow

and a resident of and resident of Lumbia District, Pagadian
City, after having duly sworn to in accordance with law, do
hereby depose and say:

1. That I am the only legitimate surviving compulsory

heir of ROSITA T. BALAOING, who died intestate
sometime 12, 2013;

2. That said decedent during her lifetime was a bona

fide member of Philam Life Insurance, Pagadian City;

3. That said deceased left no debts, nor any Last Will

and Testament;

4. That That pursuant to Sec. 1 of Rule 74 of the

Revised Rules of Court of the Philippines, I hereby
ADJUDICATE UNTO MYSELF the aforesaid PHILAM LIFE
INSURANCE PROCEEDS/BENEFIT;

IN WITNESS WHEREOF, We have hereunto affixed our

signatures this 24th day of September 2013, at Pagadian
City, Zamboanga del Sur. Philippines.

MYLEEN T. BALAOING
Affiant/Sole Heir

SINGED IN THE PRESENCE OF:

__________________ & ________________

ACKNOWLEDGMENT

BEFORE ME, personally appeared the above-named person

known to me and to me known to be the same person who
executed the foregoing instrument and she acknowledged to me
that the same is her free act and voluntary deed.

Doc. No : ____
Page No. : ____
Book No
Series of 2013
REPUBLIC OF THE PHILIPPINES)
:
IN THE CITY OF PAGADIAN…..)S.S
X------------------------------/

AFFIDAVIT
(Declaration of Heirship / Self-Adjudication of P.N.B. Bank
Accounts of Deceased Person)

I, FE CALLS SILVA, Filipino, of legal age, married and

a resident of and resident of Pagadian City, after having
duly sworn to in accordance with law, do hereby depose and
say:

3. That I am the legitimate surviving compulsory heir

of CRISPINA CALLS, who died intestate sometime in
2009;

4. That said decedent during her lifetime was a bona

fide depositor of Philippine National Bank,
Pagadian City Branch with Account Number 456-521104-
3;

3. That said deceased left no debts, nor any Last Will

and Testament;

5. That That pursuant to Sec. 1 of Rule 74 of the

Revised Rules of Court of the Philippines, I hereby
ADJUDICATE UNTO MYSELF the aforesaid P.N.B. Bank
Accounts;

IN WITNESS WHEREOF, We have hereunto affixed our

signatures this 13th day of February 2012, at Pagadian City,
Zamboanga del Sur. Philippines.

FE CALLS SILVA
Affiant/Sole Heir

SINGED IN THE PRESENCE OF:

__________________ & ________________

ACKNOWLEDGMENT

BEFORE ME, personally appeared the above-named persons

known to me and to me known to be the same person who
executed the foregoing instrument and she acknowledged to me
that the same is her free act and voluntary deed.

Doc. No : ____
Page No. : ____
Book No
Series of 2012