REPUBLIC OF THE PHILIPPINES )

CITY OF DAPITAN ) S.S.

AFFIDAVIT OF ADVERSE CLAIM

I, (Name of the Affiant), of legal age, Filipino, single and a resident of

(Affiant’s Complete resident address, after having been duly sworn to in
accordance with law, depose and state:

1. That on (Date: xx/xx/xx), I have entered into a Deed of Conditional

Sale which was acknowledged on the same date before Notary Public
(Notary Public) of Dapitan City and entered in his Notarial Register as
Doc. No. (X), Page (X), Book (X), Series of 2022.

A copy of the said Deed is hereto attached as ANNEX “A” and made
an integral part of this Affidavit;

2. That in the said Deed of Conditional Sale, I was the VENDEE of a

certain parcel of land covered by Transfer Certificate of Title No.
(xxxxxx), more particularly described as follows:
(Technical Description of Property)

3. That because I still have a balance on the purchase price in the amount
of P500,000.00 which is payable within one (1) (year) from the date of
signing thereof, it was stipulated in the aforementioned Deed that title
and ownership over the subject property will only be transferred upon
full payment of the same;

4. That the VENDOR in the said Deed of Conditional Sale agreed that
upon its execution, said Deed shall be annotated in the Title with the
Office of the Register of Deeds of Dapitan City;

5. However, since the said Deed of Conditional Sale per se could not be
annotated on the Title with the Office of the Register of Deeds, I am
therefore executing this Affidavit for the purpose of attesting to the
truthfulness of the foregoing allegations and in support of my request
for the annotation of an adverse claim over the parcel the parcel of land
covered by the Transfer Certificate of Title No. (xxxxxx).

IN WITNESS WHEREOF, I have hereunto set my hand this (nth) day

of (month, year) in Dapitan City, Zamboanga Del Norte, Philippines.

(Name of the Affiant)

Affiant
With Philippine Passport No. (xxxxx)

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 SUBCRIBED AND SWORN TO before me this (nth) day of (month,
year) in Dapitan City, Zamboanga Del Norte, Philippines, affiant exhibiting
to me her Philippine Passport No. (xxxxxx) issued in Manila on (Date issued)
and valid until (Expiry Date).

Doc. No. (xxxxxx);

Page No. (xxxxxx);
Book No. (xxxxxx);
Series of 2022.

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