AFFIDAVIT OF SELF-ADJUDICATION

I, IMEE B. MACADAT, of legal age, Filipino, married and a resident of Brgy.

Marcella, Uson Masbate, after having been duly sworn to in accordance with law,
depose and state:

1. That I am the only daughter of PIO B. BAGALIHOG who died without any last will and
testament on July 20, 2015 in Marcella, Uson, Masbate as evidenced by his Death
Certificate issued by the Municipality of Uson 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
Poblacion Uson, Masbate more particularly described in TCT No. 112233
hereto attachedas 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 Masbate 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 6th day

of September 2015 in Uson, Masbate, Philippines.

IMEE B. MACADAT

Affiant

SUBCRIBED AND SWORN TO before me this 6th day of September

2015 in Uson, Masbate, Philippines, affiant exhibiting to me her Philippine Passport No.
123456 issued in Manila on January 12, 2012 and valid until January 12, 2017.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013.