Republic of the Philippines }

Province of Isabela }
City of ________ }
x-------------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

(TCT No. ________)

I, _________________., Filipino, of legal age, and a bona fide resident of

_______________________, after having been duly sworn to in accordance with
law, depose that:

(1) In __________, 2002, _____________ executed a Deed of Sale in my

favor. The property that was sold to me is a parcel of land situated in
______________, Isabela, and is covered by TCT No. ____________

(2) The Deed of Sale was notarized by ________________. , and was

entered in his notarial register under docket no. _____; Page No. _____;
Book No. _____; Series of 2002. A copy of the said Deed of Sale is
hereto appended as Annex “A” to “A-2.”

(3) The owner’s copy is with me.

(4) I was informed that __________________ is again selling the same land
unto several persons, and that upon further inquiry at the Registry of
Deeds of Isabela, she was able to get an order for the replacement of
owner’s copy, of the same land.

(5) I am requesting the Registry of Deeds to register this Adverse Claim

because the then vendor, is again selling the same land to several
persons, when she already sold the land to me.

IN WITNESS WHEREOF, I set my hand this ____ day of _________, 2022 in

__________________________.

_________________
Affiant
ID _________________

SUBSCRIBED AND SWORN TO BEFORE ME on the same date and at the same
place above-written.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2022.