Republic of the Philippines )

Province of _______________ ) S.S.

Municipality of _____________)

AFFIDAVIT
( IN SUPPORT OF RESIDENTIAL FREE PATENT APPLICATION )

I, ________________________, Filipino, single/married, of legal age and a resident of

____________________________________________________, after having been duly sworn to an
oath in accordance with law, hereby depose and say:

1. That i personally know _________________________ who has filed an application for

residential free patent over a parcel of land located at ______________________
____________________________________________;

2. That I am an actual resident of _______________________ of the City/Municipality of

_________________________________ and that I know the land applied for very well;

3. That I personally know that the said applicant or his/her predecessor-in-interest has
actually resided on and continuously possessed and occupied, under a bona fide claim of
acquisition of ownership, the subject land for at least ten (10) years by himself or through
his predecessors-in-interest;

4. That I am not related to the applicant either by consanguinity or affinity and not, in any way,
interested in the residential land applied for in the granting of a residential free patent; an

5. That to the best of my knowledge, belief and information, he/she has the qualifications to
apply for residential free patent under RA 10023.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ths day of _______________,
20______ in the place above written.

_______________________
Affiant
CTC No. _______________________
Issued on _____________________ at _______________________________________.

SUBSCRIBED AND SWORN to before me on the date and place stated above.

________________________
Officer Authorized to
Administer Oath