AFFIDAVIT OF VOLUNTARY

SURRENDER OF LANDHOLDING.

REPUBLIC OF THE PHILLIPINES )

MUNICIPALITY OF . . . . . . . . . . ) SS.
PROVICE OF . . . . . . . . . . . . . . . .)

AFFIDAVIT

I, . . . . . . . . . . . . . . . . . . . . . . . . , of legal age, single/ married to

. . . . . . . . . . . . . . . . . . . . . . ., Filipino, and resident of . . . . . . . . . . . . . . .
after having been duly sworn on oath in accordance with law, freely and
voluntarily, without undue pressure from anyone or fear of intimidation,
hereby depose and say:
That I am the agricultural lessee of the Riceland owned by . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . ., situated in the barrio of . . . . . . . . . . . . . . .
Municipality of, . . . . . . . . . . . . . . . . . , Province of . . . . . . . . . . . . . . . . . . .,
with an area of . . . . . . . . and covered by Certificate of Title No. . . . . . . .;
That I have this date notified said landowner of my intention to
terminate the leasehold, and transfer to another locality with my family
whereon I intend to spend my last remaining years, as I am well advanced
in age;
That I hereby voluntarily surrender the above-described
landholding unto the said . . . . . . . . . . . , for the reason that I cannot
continue the leasehold or reside on his land.
IN TRUTH WHEREOF, I have hereunto set my hands this . . . day of
. . . . . . . . . . . . . . , 19 . . . . , at . . . . . . . . . . . . . .

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Affiliant