MISAMIS ORIENTAL AND CAMIGUIN

NAME OF ARB/s: _________________________________________________

Female Actual Occupant
Male Not Actual Occupant

ADDRESS: _________________________________________________

CONTACT NUMBER: ______________________________________________

DETAILS OF CERTIFICATE OF LAND OWNERSHIP AWARD / EMANCIPATION PATENT

CLOA
TITLE NO. : _________________________________________________
EP

LOT NO. : _________________________________________________

AREA: _________________________________________________
ADDRESS: _________________________________________________
OUTSTANDING OBLIGATION:________________________________________

Status: In the List of Condonation In case of unverified status, the ARB

Verified was contacted by:

Unverified
Verifier: Name:
Time: Time:
Date: Date:
________________________________________________________________

Status: Release of COCROM

Received by: ____________________________

Date/Time: ____________________________

Verified and Released by: Date and Time:

________________________________ _______________________

Additional information / remarks:

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________.