LTC Form No.

Republic of the Philippines) LTC Application No. _____

Municipality of La Trinidad)
Province of Benguet) s.s

APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCE

We, Novert F. Lagawad, of legal age, married to Anabel L. Lagawad, and Dexter
Sawasi Contes, of legal age, married to Galmian G. Contes, all Filipinos, all of legal ages, and
all residents of Iwa, Kibungan, Benguet, Philippines, hereinafter referred to as the
TRANSFERRORS and TRANSFERREEs, after having been duly sworn to in accordance with
law, do hereby depose and state that:

1. We are the parties in that DEED OF DONATION of a PORTION PARCEL OF

UNREGISTERED LAND dated _________________ as per Doc. No. ______; Page No.
_____; Book No. I; Series of 2023; of Notary Public Atty. Shekina B. Manghi,
involving a portion of land covering an area of Nine Thousand Four Hundred Ten (9,410)
square meter more or less, covered and embraced by the Tax Declaration/ARP No. 2010-
10-01-02512 with a total area of (4.1191 Ha.), more or less, situated in Lingey, Liwen,
Poblacion, Kibungan Benguet.

2. This application for the issuance of Land Transfer Clearance (LTC) is not contrary to law
because all 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;

3. 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):

3.1. 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 ____

3.2. 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)

4. 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 La
Trinidad, Benguet, Philippines.

Novert F. Lagawad Anabel L. Lagawad

Transferor Spouse/Transferor
Valid ID No. __________________

Dexter Sawasi Contes Galmian G. Contes

Transferee Spouse/Transferee
VIN No. 1109-0028B-C0179DSC10000

SUBSCRIBE AND SWORN to before me this ______________ at La Trinidad,

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

WITNESS MY HAND AND SEAL.

ATTY. SHEKINA B. MANGHI

Doc. No. ____; Notary Public until December 31, 2024
Page No. ____; PTR No. BGTCF7720438; Jan. 10,2023
Book No. I; IBP OR no. 273571;01/06/2023
Series of 2023. Roll No. 83803, June 14, 2022; Manila
Sunburst Bldg., FA 224, Km. 4, La Trinidad,
Benguet

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