REPUBLIC OF THE PHILIPPINES)

____________________________) S.S.

AFFIDAVIT OF NO IMPROVEMENT

I, _____________________________, of legal age, Filipino, single/married, and

resident of _______________________________________, after being sworn
according to law, hereby depose and state that:

1. I am the registered owner of a parcel of land situated at

_______________________________________, covered by Transfer Certificate of Title
No. __________ of the Registry of Deeds for _____________________, containing an
area of _________ square meters, more or less.

2. The above parcel of land is a vacant lot since there are no improvements
or structures built thereon whatsoever.

3. I am executing this affidavit to attest to the truth of the foregoing

statements and for whatever legal purpose this may serve.

AFFIANT FURTHER SAYETH NAUGHT.

[Signature above Printed Name]

Affiant

SUBSCRIBED AND SWORN to before me this _____________________ at

_________________________, affiant exhibited to me his/her Competent Evidence of
Identity by way of ____________________ issued at ___________________ on
_______________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______.