Republic of the Philippines )

City/Municipality of ) S.s
Province of ________________)

APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCE

WE, Lauro C. Cadorniga, of legal age, Filipino citizen, married to Cristina E. Cadorniga
and resident of Namunga, Rosario, Batangas, for himself and as Attorney-In- Fact of Lauro E.
Cadorniga 1, of legal age, now married to Amy Brown Cadorniga, and Bamboo Mosaic
Properties Inc., a corporation duly organized and existing under the laws of the Philippines
with office address at 93 Araullo Street, Addition Hills, San Juan City represented by this act by
its President, Andrew S. Co, after being sworn in accordance with law, hereby depose and state:

1. We are the parties in a Deed of Absolute Sale involving a parcel of land covered by OCT
No. P-34408, with Lot Not No.9598, Survey No. Cad-436-D, with an area of 20,674 square
meter more or less and located at Namuco , Rosario, Batangas declared under Tax
Declaration No. 19-0031-02923, OCT No. P39626, Lot No. 9596, Survey No. Cad-426-D, with
an area of 8,665 square meter more or less and located at Namuco, Rosario, Batangas
declared under Tax Declaration No. 19-0031-02075, and OCT No. P-40821, Lot No. 9597,
Survey No. Cad-426-D, with an area of 10,010 square meter more or less, and located at
Barangay Namuco, Rosario, Batangas declared under Tax Declaration No. 19-0031-01797.

2. This application for the issuance of Land Transfer Clearance (LTC) is not contrary to law
because both of us are qualified to dispose and acquire described above. In addition, the
said land is neither covered under the agrarian reform program not within the CARPER
LAD balance and that the deed/contract will not violate the retention limit provided under
the law.

3. In support thereto and compliance with DAR A O No. 4 Series of 2021, the mandatory
documents are hereto attached and made integral part hereof as appropriate box.

3.1. FOR THE TRASFEROR:

 Official Receipt :Annex____

 Electronic Copy of the Title :Annex____
 Affidavit of Aggregate Landholding :Annex____
 Affidavit of Retention Non Tenancy/tenancy with :Annex____
Compliance of tenant’s right of Pre-emption and/
or Redemption and no pending case before the
land subject of the transaction, if there is a case
before the regular courts or any other tribunal the
same had been decided with finality or Affidavit of
transferee in the case of extrajudicial settlement
 City Assessor’s Certificate of Aggregate Landholding :Annex____
 Provincial or City Assessor’s Certificate if not a :Annex____
resident of Batangas Province

3.2 FOR THE TRANSFEREE:

 Affidavit of Aggregate Landholding :Annex____

 City Assessor’s Certificate of Aggregate Landholding :Annex____
 Provincial Assessor’s Certificate of Aggregate :Annex____
Landholding
  Municipal Agrarian Reform Program Officer :Annex____
Certification (LTC form No.2)
 Provincial or City Assessor’s Certificate if not a :Annex____
resident of Batangas Province
 Special Power of Attorney (if applicable) :Annex____
 Secretary’s Certificate (in case of a corporation) :Annex____

4. Having submitted/attached hereof the mandatory documents as required under DAR

A.O No.4, Series of 2021, I/we hereby file this instant application/request to facilitate the
issuance of the corresponding Certificate of LTC.

IN WITNESS WHEREOF, we have hereunto set our hands this ____ day of ___ 20___ at
______________, Philippines

___________________________________ ___________________________________
BAMBOO MOSAIC PROPERTIES INC. LAURO C. CADORNIGA
BY: ANDREW S. CO

ID No. Tin no. 185-402-141 ID No. Tin no. 902-377-586

Date Issued: Date Issued:
Place Issued: Place Issued:

SUBSCRIBED AND SWORN to before me this _____ day of ___20 at

____________________ affiants upon exhibiting to me their duly issued government IDs
with details stated above.

NOTARY PUBLIC

Doc No. ____

Book No.____
Page No. ____
Series of 20___