PRLD.0002-B.

02

NATIONAL CAPITAL REGION

REGISTRATION STATEMENT
(For Single Proprietorship)

I, , Filipino, of legal age, single / married, with

postal address and residence at ,
after being sworn in accordance with the law, do hereby state that:

1. I am engaged in the business of

with capitalization of ;

2. I am the owner of
certain parcel(s) of land located at
covered by TCT No. (s)
comprising an aggregate area of sq.m.

3. That I am developing said parcel(s) of land into a

(Type of Project)
herein after called

4. As the owner, and , as the developer

(Name of Developer)

5. The project, I undertake to develop said project in accordance with the plans
approved by the _ _.
(Approving Institution)

6. Attached hereto is the Declaration of UDHA Compliance, pursuant to the

implementing rules and regulations and circulars issued under Section 18 of
Republic Act No. 7279.

(Fill-out the attached Declaration of UDHA Compliance form for

main subdivision project or compliance project)

7. My authorized broker(s) shall be

_

8. In my capacity as owner of the project, I bind myself to comply with all the rules
and regulations pertaining to this project and shall be held responsible for all the
facilities, improvement, infrastructures and similar form of development hereon.

Date Place

Affiant

SUBSCRIBED AND SWORN to before me this day of ,

20____, affiant exhibiting to me issued in _____________
on .

NOTARY PUBLIC

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