DAR Clearance Form 1- A

Republic of the Philippines )

Municipality of _________________________ ) S.S
Province of Bohol )

AFFIDAVIT OF AGGREGATE LANDHOLDING

(TRANSFEROR)

I/WE, ____________________________________________________________ , Filipino,

of legal age, married/single with residence and postal address at
Trigon Area, San Isidro, Talibon, Bohol
_______________________________________________________, after having sworn according
to law, hereby depose and say:

1. That I/We own a total aggregate agricultural landholding of

_________________ square meters/hectares including the area of
___________ square meters/hectares, more or less, that I/We
transfer to
______________________________________________________,
Local Government Unit of Talibon
under Doc. No. ______; Page No.______; Book No. _____; Series of
20_____; of Notary Public Atty.
______________________________________ dated
____________________ ; and

2. That this affidavit is executed in compliance with DAR Administrative

Order No. 4, Series of 2021, as well as to show proof that the land
subject of the above-mentioned transaction is my retention area or
part of my retention area.

AFFIANT SAYETH NONE:

Talibon, Bohol
(Place)

(Date)

Affiant Affiant
(Signature over printed name) (Signature over printed name)

SUBSCRIBED AND SWORN to before me this ________ day of _______________________

20______ at __________________________________ affiant exhibited his/her ID/Community
Tax
Certificate No. ____________ issued at ___________________________________________
on
_______________________, 20______.

NOTARY PUBLIC
Doc No. ______;
Book no. ______;
Page No. ______;
Series of 20_____