REPUBLIC OF THE PHILIPPINES )

DIPOLOG CITY ) S.S.

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

AFFIDAVIT OF BUYER
We, ________________,Filipinos,of legalages, married to each other, and residents of
__________________________, under oath, depose and state that:

1. We are the buyers of a certain parcel of land, which are covered by Original
Certificate of Title No.T-0000,more particularly described as follows:

“A parcel of land (Lot 6-D-2) of the subdivision plan, PSD-09-

039995 being a portion of Lot 2066-D, Psd-41165 LRC Cad. Rec.
No. situated in the Barangay ______________ x xx containing
an area of THREE THOUSAND FOUR HUNDRED
THIRTEEN (3,413) SQUARE METERS. “

2. By virtue of these presents, we hereby state that our total aggregate landholding
does not exceed five (5) hectares; and

3. This affidavit is executed in good faith to attest to the truth of the foregoing facts
in compliance with the provisions of the Agrarian Reform Law and for all
purposes this may legally serve.

IN WITNESS WHEREOF, we have affixed our signature this ____________________ at

____________________.

____________ ________________
Affiant Affiant

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

DIPOLOG CITY ) S.S.

BEFORE ME this __________________at ___________ personally appeared the following

persons who exhibited to me their respective identification documents as competent proof of
identity:

known to me and to me known as the same person who executed and signed the foregoing
Petition for Cancellationof a Lien consisting of one (1) page including this page, and
acknowledged to me that the same is their free and voluntary act and deed.

WITNESS MY HAND and OFFICIAL NOTARIAL SEAL.

Doc. No.
Page No.
Book No.
Series of 2014.