Republic of the Philippines)

Province of Masbate ) S.S.

City of Masbate )

AFFIDAVIT OF RELINQUISHMENT
(In favor of the Republic of the Philippines)

I, Norberto Ragot Sr, of legal age, Filipino and a resident of Brgy. Bagauma, Aroroy,
Masbate after having been duly sworn to in accordance with law, hereby depose and say:

That I am the previous applicant of a certain land for residential purposes pursuant to
the provisions of Act. No. 3077 and Bureau of Lands Administrative Order No. 08 as amended,
with an area of Five Hundred (500) square meters, with boundaries more particularly described
as:
R.P.A. No. 054101-02 located in Bagauma, Aroroy, Province of Masbate;

North = Seashore
East =Foreshore Land
South= Lita Jeremias
West =Foreshore land

That I freely and voluntarily and permanently give and relinquish all my rights/claims
over the said parcel of land with an area of Five Hundred ( 500) square meters in favor of the
Republic of the Philippines;

Further I certify that my consent is permanent and cannot be revoked or set aside,
unless the Courts of law sets aside my consent;

That I have executed this affidavit to attest to the truth of all the foregoing and for
whatever purpose this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this ___________________ in the

City of Masbate, Philippines.

__________________________
Affiant
SIGNED IN THE PRESENCE OF:

_______________________ _______________________

JURAT

SUBSCRIBED AND SWORN to before me this _________________affiant exhibited to

me his _________________________ valid until___________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017;