Republic of the Philippines )

City of _____________ ) S.S

X ------------------------------ X

AFFIDAVIT
(RE: PETITION TO SPLIT)

I, ____________, of legal age, married, and a resident of

____________________, after having duly sworn to an oath hereby declare:

That I am the owner of that parcel of land being the only living surviving
heir of the registered owners, the late _________________, per Affidavit of
Self-Adjudication entered in the notarial registry of __________________,
over property particularly known and identified as Lot _______________,
containing an area of __________________, and covered by Transfer
Certificate of Title No. ______________________;

That I have caused the above-described parcel of land to be subdivided

into three (3) resultant sub-lots and designated as Lot nos. ______________;

That partition and splitting is sought herein, for the common benefit of the
co-owners, in the event that I will be planning to dispose of the same, to preserve
and secure our respective interest and rights in the property;

That this affidavit is executed to attest to the truthfulness of the

aforementioned facts, particularly to establish that the subdivided lot nos.
________________ be registered in my name.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____________, at ____________, Philippines.

Signed in the presence of: ________________ __________________

SUBSCRIBED AND SWORN TO BEFORE me this ___, at _____,

Philippines, Affiant exhibited to me her competent evidence of identity as
indicated below his respective name and signature.