Republic of the Philippines )

)s.s.

AFFIDAVIT OF NO REAL/PERSONAL PROPERTY

I, X, 59 years old, Filipino citizen, married and a resident of A, after having been
sworn in accordance with law, hereby depose and say:

1. That I am a sister of Y who died on October 5, 2017;

2. That Y was in my care before her demise since she died single and without
issue;

3. That Y has no real/personal property except of our savings account in First

Valley Bank in the amount of Php 12, 607.86 with account name Y;

That I execute this Affidavit freely and voluntarily to attest to the foregoing facts
and for whatever legal purpose this may serve.

FURTHER, Affiant sayeth none.

IN WITNESS WHEREOF, I hereunto set my hand this 11th day of October 2017
at B, Philippines.

X
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of October 2017 at B,

Philippines.