REPUBLIC OF THE PHILIPPINES)

CITY OF TARLAC ) S.S.

AFFIDAVIT OF ADVERSE CLAIM

I, ______________, of legal age, Filipino citizen, and with residence and

postal address at ___________________, after having been duly sworn to in
accordance with law, do hereby depose and state, - THAT:

1. I am the absolute owner of a parcel of land located in containing an area of

25,613 and covered by Transfer Certificate of Title (TCT) No., still in the
name of, (“Subject Property”, for brevity);

2. I acquired the Subject Property from in year 2000, by virtue of a Deed of

Extrajudicial Settlement of Estate with Deed of Absolute Sale, a copy of
which is hereto-attached as ANNEX “A”;

3. Upon consummation of the sale, the Owner’s Duplicate Copy of Transfer

Certificate of Title (TCT) No., (“lot title” for brevity) was voluntarily
turned over to me and I together with my family, entered and occupied the
Subject Property;

4. Meantime, I placed the lot title in the possession of, one of my children, for
safekeeping; however, the said lot title was among those destroyed and
lost when our house in was intentionally burned down by a certain who
was eventually convicted for the crime of Arson;

5. In 2003, filed a case against me for Recovery of Ownership, Quieting of

Title and Damages involving the Subject Property docketed as ;

6. However, the said case was dismissed in a Decision (ANNEX “B”)

rendered on 6 November 2012 which eventually gained finality on as
evidenced by a Certificate of Finality, a copy of which is hereto-attached as
ANNEX “C”;

7. But sometime in 2015, instead of abiding by the Decision, the heirs of

forcibly entered the Subject Property and prevented me and my family
from tilling and cultivating the same and even demolished the
improvements made thereon;

8. Recently, I was informed that the heirs of are offering the Subject Property
for sale to prospective buyer/s;
 9. Considering the lost of the lot title; the fact of our dispossession of the
Subject Property and refusal of the to respect and abide by the Decision of
the MTC; and the attempts of the to sell the Subject Property, I am in
danger of being defrauded and deprived of my valid right over the Subject
Property, not to mention the possibility that third parties could likewise be
defrauded to their detriment, UNLESS AN ADVERSE CLAIM IS
ANNOTATED ON THE SAID LOT TITLE;

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

annotation of an adverse claim over the subject parcel of land described
herein;

IN WITNESS WHEREOF, I have hereunto set my hand this 29th day

of January 2021 in Tarlac City, Philippines.

Affiant

SUBCRIBED AND SWORN TO before me this 29th day of January 2021 in

Tarlac City, Philippines.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.