Republic of the Philippines )

City of __________ ) S.S.

AFFIDAVIT OF ADVERSE CLAIM

I, (NAME OF AFFIANT), of legal age, Filipino, single/married, and a resident of

(Place of Residence), after having been sworn to in accordance with law, depose and
say – THAT:

1. I am one of the heirs of the late (Name of Deceased Ascendant/Parent/s);

2. By hereditary succession, ownership and other real rights are transmitted by law to me
and my co-heir over the parcel of land located at (Location of Property), more
particularly described as follows:

(Technical Description of Property)

3. It has come to my knowledge that (Name of Person Involved) has caused the titling in
his/her name and is presently claiming to have an interest over the said parcel of land;

4. Clearly, said title and claim are based on forged or fraudulent documents executed
sometime on (Date) in favor of the (Name of Person Involved), copies of which are
attached herein;

5. Unless an adverse claim is annotated on the said Original Certificate of Title, the heirs of
(Name of Deceased Ascendant/Parent/s) are in danger of being defrauded and deprived of their
just and valid right over the said parcel of land; and

6. As such, I am executing this Affidavit in support of my request for the annotation of an

adverse claim over the parcel of land described herein.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this (Date), in

(Place), Philippines.

(NAME OF AFFIANT)
Affiant
 SUBSCRIBED AND SWORN to before me this (Date) in (Place), with affiant
exhibiting to me his (ID details), a government-issued ID bearing his/her signature and
photograph.

Doc. No. ____;

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