REPUBLIC OF THE PHILIPPINES)

CITY OF GENERAL SANTOS) S.S.

x-------------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, __________________________, of legal age, Filipino, single

and a resident of ________________________________________,
after having been duly sworn to in accordance with law, depose and
state:
1. That on _______________, I have entered into a Deed of Conditional
Sale which was acknowledged on the same date before
____________________________ of _____________________ and
entered in his Notarial Register as Doc. No. 2, Page 2, Book II, Series
of 2013. A copy of the said Deed is hereto attached as ANNEX
A and made an integral part of this Affidavit;
2. That in the said Deed of Conditional Sale, I was the VENDEE of a
certain parcel of land covered by Transfer Certificate of Title No.
111222,
more particularly
described
as
follows:
(Technical Description of Property)
3. That because I still have a balance on the purchase price in the
amount of ______________ which is payable within _____________
from the date of signing thereof, it was stipulated in the
aforementioned Deed that title and ownership over the subject
property will only be transferred upon full payment of the same;
4. That the VENDOR in the said Deed of Conditional Sale agreed that
upon its execution, said Deed shall be annotated in the Title with
the Office of the Register of Deeds of _______________ City;
5. However, since the said Deed of Conditional Sale per se could not be
annotated on the Title with the Office of the Register of Deeds, I am
therefore executing this Affidavit for the purpose of attesting to the
truthfulness of the foregoing allegations and in support of my request
for the annotation of an adverse claim over the parcel of land covered
by the Transfer Certificate of Title No. 111222.

IN WITNESS WHEREOF, I have hereunto set my hand

this __th day of ___________ 20__ in _______________________.

_____________________
Affiant

SUBCRIBED AND SWORN TO before me this __th day of

___________ 20__ in _______________________________, affiant
exhibiting to me her Philippine Passport No. _________ issued in
__________ on _______________ and valid until ______________.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2016.