Republic of the Philippines

Province of _________________
City of __________________
x-------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, _________________ Filipino, of legal age, married, and a resident of

_________________, ___________________________, depose that:

(1) I own a real property in barangay ________________,

____________________. It is now covered by lot No. _______________.

(2) A certain ________________ misrepresented that she is the owner of

the said lot, through purchase. When in fact, the sale was never
consummated.

(3) Through the misrepresentation of _____________, the lot was

registered under her name, and is now registered at the Registry
of Deeds of ______________, under Transfer Certificate of Title No.
______________________

(4) I am requesting the Register of Deeds of _______________to

annotate this adverse claim on the said title, which shall serve as a
warning to third parties dealing with the property that I have a
better right than that of the registered owner.

IN WITNESS WHEREOF, I set my hand this ____ day of May 2019 in

_________________________.

_________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the same date and

at the same place above-written.
The affiant has his ID ____________________

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2019.