Republic of the Philippines )

City of (Place) ) S.S.

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

AFFIDAVIT OF LOT OWNER’S CONSENT

I, (Name of Affiant – Lot Owner), of legal age, Filipino, married/single, and a resident
of (Place of Residence), after having been duly sworn in accordance with law, hereby depose and
state:

1. That I am the owner of the lot covered by Certificate of Title No. (Title Number), Cadastral Lot
No. (Number) located in in (Place);

2. That (Name of Lot Occupant) of (Address of Lot Occupant) had built a house in the said lot
since (Year);

3. That I have no objections and am giving my full consent to such improvement in my lot;

4. That I am executing this affidavit to declare the truth of the foregoing facts and for whatever legal
purpose it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this (Date) at (Place), Philippines.

(NAME OF AFFIANT)
 Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this (Date) in the City of (Place),

Philippines, by (Name of Affiant), who presented her (Identification Card Details), issued
on (Date) at (Place).

Doc. No. _____;

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