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REPUBLIC OF THE PHILIPPINES)

City of Manila
) S.S.
EXTRA-JUDICIAL SETTLEMENT
WE, FELIPE R. DY and MARIA FLORISA TUMBOCON, of
legal ages, Filipino Citizens, Widower and Single and
residing at No. 759 San Sebastian Street, Quiapo, Manila,
under oath depose and state:
1. That I, FELIPE R. DY am the Surviving Spouse of
the deceased, Marissa Tumbocon Dy and I MARIA FLORISA
TUMBOCON, is the Daughter of the deceased, Marissa
Tumbocon Dy, who died on died on June 23, 2015 at Mary
Chiles General Hospital, Gastambide, Samplaoc, Manila;
2. That Marissa Tumbocon, during her lifetime,
left a Bank Account
Deposit (Time Deposit ) with the MetroBank, Recto
Branch, City of Manila inder Bank Account No. 082-108202156-4, in the amount of One Hundred Thousand
Pesos (P100, 000.00);
3. That we Adjudicate unto ourselves the abovestated Deposit of the late Marissa Tumbocon Dy;
4. That there are no other Surviving Heirs, except
herein Affiants;
5. That We execute this Settlement to attest to the
truth that We are the only Surviving Heirs of the late
Marissa Tumbocon Dy and that the Bank Deposit (Time
Deposit ) with the MetroBank, Recto Branch, City of Manila
under Bank Account No. 082-1-08202156-4 is hereby
adjudicate unto ourselves the amount of One Hundred
Thousand Pesos (P100,000.00) which is the amount of the
Time Deposit.
IN WITNESS WHEREOF, We have hereunto affixed our
my signatures this 24th day of February 2016 at the City of
Manila, Philippines.
FELIPE R. DY
MARIA FLORISA
TUMBOCON
Affiant
Affiant
Voters ID No. 3903-1954ASocial
Security System (SSS )ID No.
E2657FRD20000-2
3426210170
Issued the Commission on Elections
issued
at SSS Office
COMELEC Office, NCR-Manila, 1st District.
Quezon
City

SUBSCRIBED AND SWORN to before me this 24 TH day


of February 2016, Affiants, exhibiting to me their
abovementioned competent evidence of identity issued on
the dates and places afore-stated.
NOTARY PUBLIC
Doc. No.
Page No.
Book No.
Series of 2016.