拋 棄 繼 承 權 聲 明 書

Disclaimer of Right to Inheritance

知悉得繼承日期：中華民國 年 月 日

Date of becoming aware of the right to inheritance: R.O.C. year month day

被 繼 承 人 Deceased	姓名 Name	性別 Sex	出生日期 Date of birth	民國 年 月 日 R.O.C. year month day	死亡日期 Date of death	民國 年 月 日 R.O.C. year month day

戶籍所在地址 Household address	縣County 鄉市Township/ 村Village 鄰Neighborhood 市City 鎮區City/Dist. 里

路Rd. 街St. 段Sec. 巷Lane 弄Alley 號No. 樓Floor
立書人聲明：依中華民國民法第1174條規定拋棄對被繼承人之繼承權 Declaration: In accordance with Article 1174 of the Civil Code of the Republic of China (Taiwan), the undersigned waives the right to inherit his/her share of the intestate estate that he/she might be entitled to receive from the deceased above.
立 書 人 Disclaimant	姓名 Name	出生日期 Date of birth	護照或身分證號碼 Passport or ID no.	與被繼承人之關係 Relationship to the deceased

住址 Address	立書人Disclaimant 法定代理人Legal representative （簽章） (Signature)

備註：依據中華民國民法第1174條及第1176條條文，拋棄繼承應於繼承人知悉其得繼承之時起三個月內以書面向法院為之。拋棄繼承後，應以書面通知因其拋棄而應為繼承之人。但不能通知者，不在此限。因他人拋棄繼承而應為繼承之人，為拋棄繼承時，應於知悉其得繼承之日起三個月內為之。 Note: Pursuant to Article 1174 of the Civil Code of the Republic of China (Taiwan), “an heir may waive his or her right to an inheritance. Such waiver . . . must be asserted by a written declaration to the court within three months after becoming aware of his or her right to the inheritance. After the waiver of inheritance, he or she shall notify in writing the person who is entitled to succeed the inheritance due to his or her waiver unless such a notification is impractical.” In addition, pursuant to Article 1176 of the Civil Code, “where a person, who becomes an heir due to the waiver of other heirs, waives his or her right to the inheritance, such waiver must be conducted within three months after becoming aware of his or her right to the inheritance.”