LTC Form No.

Republic of the Philippines) LTC Application No. _____

Municipality of _______________)
Province of ___________________) S.S.

APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCE

We, LEONARDO GABOL, of legal age, married, Filipino, and resident of San
Gabriel, La Union, Philippines, the VENDOR, and the undersigned VENDEE, Diego R.
Palantog, of legal age, married, Filipino, and with address at Loo, Buguias, Benguet,
Philippines, after being sworn in accordance with law, hereby state:

1. We are the parties in a DEED OF ABSOLUTE SALE OF UNREGISTERED PARCEL

OF LAND involving a parcel of land declared under Tax Declaration Number
(TD)/Assessment of Real Property (ARP) No. 2010-08-12-00411 containing a
land area of Two Hectares (2.0000 Ha.) located at Elengan, Loo, Buguias,
Benguet;

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 the land described above. In
addition, the said land is neither covered under the agrarian reform program nor within
the CARPER LAD Balance, and that the deed/contract will not violate the retention limit
provided under the law;

1. In support thereto and in compliance with DAR A.O. No. 04, Series of 2021, the
pertinent applicable documents are hereto attached and made integral parts hereof as
(please check appropriate box):

1.1. FOR THE TRANSFEROR:

/ Official Receipt : Annex ____

Electronic Copy of the Title or Tax Dec : Annex ____
Deed or document to be registered : Annex ____
Affidavit of Aggregate Landholding INCLUDE SPOUSE : 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 regular
courts or any tribunal involving the land subject of the
transaction, if there is a case before the regular courts
or any tribunal the same had been decided with finality
Municipal Assessor’s Certificate of Aggregate : Annex ____
City Assessor’s Certificate of Aggregate Landholding : Annex ____
Provincial Assessor’s Certificate of Aggregate Landholding : Annex ____

1.2. FOR THE TRANSFEREE:

Affidavit of Aggregate Landholding INCLUDE SPOUSE : Annex ____

Municipal Assessor’s Certificate of Aggregate Landholding: Annex ____
City Assessor’s Certificate of Aggregate Landholding : Annex ____
Provincial Assessor’s Certificate of Aggregate Landholding: Annex ____
Municipal Agrarian Reform Program Officer : Annex ____
(LTC Form No. 2)

2. Having submitted/attached hereof the applicable mandatory documents as required under

DAR A.O. No. 04, Series of 2021, I/we hereby file this instant application/request to
facilitate the issuance of the corresponding Certificate on LTC.

IN WITNESS WHEREOF, we have hereunto set our hands this ___________ at

___________________________, Philippines.
 LEONARDO GABOL
Applicant
Valid ID No. ___________________

DIEGO R. PALANTOG
Applicant
Valid ID No. __________________

SUBSCRIBE AND SWORN to before me this _____________ at

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

Doc. No.: _____;

Page No.: _____;
Book No.: _____;
Series of _____;

Copy Distribution:
Original – DARPO/LTC Folder
Duplicate – Applicant