REPUBLIC OF THE PHILIPPINES)

CITY OF DUMAGUETE .............…) S.S.

AFFIDAVIT OF TRANSFEROR

I, NERISA RUIZ SAYCON, of legal age, Filipino, single and a resident of

Pamplona, Negros Oriental, Philippines, on oath, depose and say:

That I am the absolute and registered owner of a parcel of land known as Lot No.
2179, Pls-759, containing an area of One Thousand Fifty Four (1,054) square meters,
situated in Lipayo, Dauin, Negros Oriental and covered by Original Certificate of Title
No. 2306;

That the said parcel of land has no pending civil or criminal case at the
Department of Agrarian Reform Adjudication Board (DARAB), or any of its Adjudicators,
the Department of Agrarian Reform (DAR), the courts or at the Office of the President;

That I am executing this affidavit to attest to the truthfulness and veracity of the
foregoing statements and for whatever legal purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________

at Dumaguete City, Negros Oriental.

NERISA RUIZ SAYCON

Affiant
ID No. _________________

SUBSCRIBED AND SWORN to before me this _________________, at Dumaguete

City, Philippines, by the affiant who showed to me as competent proof of identity her
identification card written below her name.

Doc. No.: ____

Page No.: _____
Book No.: ____
Series of 2018.