7/21/2019 55600249 Sample Adverse Claim

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Republic of the Philippines)Province of ____________________)S.S.City/Municipality of _____________)

x - - - - - - - - - - - - - - - x

AFFIDAVIT OF ADVERSE CLAIM

I,_____________, of leal ae, !ilipino, "sinle / #arrie$ / %i$o%), an$ aresi$ent of _____________, Philippines, after havin been s%orn to inaccor$ance %ith la% $epose an$ say&'.(n _____________, I have entere$ into a ee$ of Con$itional Sale %hich%as ac*no%le$e$ on the sa#e $ate before +otary Public _____________ of _____________ an$ entere$ in his +otarial Reister as oc. +o. ______Pae +o. ______ oo* +o. ______, Series of ______. copy of the sai$ee$ is hereto attache$ an$ #a$e an interal part of this ffi$avit.0hat in the sai$ ee$ of Con$itional Sale, I %as the 12+22 of a certain

parcel of lan$ covere$ by 0ransfer Certificate of 0itle +o. _____________,#ore particularly $escribe$ as follo%s&0echnical escription of Property)3.0hat, because I still have a balance on the purchase price in the a#ount ofP_____________ %hich is payable %ithin _____________ "______)"year/#onths) fro# the $ate of sinin thereof, it %as stipulate$ in theafore#entione$ ee$ that title an$ o%nership over the sub4ect property %illonly be transferre$ upon full pay#ent of the sa#e5.0hat the 12+(R in the sai$ ee$ of Con$itional Sale aree$ that upon itsexecution, sai$ ee$ shall be annotate$ in the 0itle %ith the (ffice of theReister of ee$s of _____________6. 7o%ever, since the sai$ ee$ of Con$itional Sale per se coul$ not beannotate$ on the 0itle %ith the (ffice of the Reister of ee$s, I a# thereforeexecutin this ffi$avit for the purpose of attestin to the truthfulness of theforeoin alleations an$ in support of #y re8uest for the annotation of ana$verse clai# over the parcel of lan$ covere$ by the 0ransfer Certificate of0itle +o. _____________.I+ 9I0+2SS 972R2(!, I have hereunto set #y han$ this _____________in the City/Municipality of _____________, Philippines. ffiant":;R0)

Republic of the Philippines)

7/21/2019 55600249 Sample Adverse Claim

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Province of ________________)S.S.City/Municipality of _____________)x - - - - - - - - - - - - - x

AFFIDAVIT OF ADVERSE CLAIM

I, _____________, of leal ae, !ilipino, "sinle / #arrie$ / %i$o%), an$ aresi$ent of _____________, after havin been s%orn to in accor$ance %ithla%, $epose an$ say&

0hat I a# one of the heirs of the late _____________.

0hat a certain _____________ previously entere$ into a ee$ of Con$itionalSale %ith the "<overn#ent Service Insurance Syste# "<SIS) or Pa-II<) forthe purchase of a parcel of lan$ "inclu$in the i#prove#ents thereon) locate$at _____________, #ore particularly $escribe$ as follo%s&

"0echnical escription of Property) 0hat on _____________, _____________execute$ a "ee$ of 0ransfer of Rihts / ssu#ption of (bliations) in favorof the late _____________, %hich $ocu#ent is #ore particularly i$entifie$ asocu#ent +o. ______, Pae +o. ______, oo* +o. ______, Series of ______ in the +otarial Reister of +otary Public _____________ an$ a copyof %hich is attache$ herein.

0hat in sai$ "ee$ of 0ransfer of Rihts / ssu#ption of (bliations), _____________, for valuable consi$eration receive$, ce$e$, transferre$ an$

conveye$ to _____________, his heirs, successors an$/or assins, all hisrihts, interest an$ participation in the purchase of the afore$escribe$ parcelof lan$.

0hat as such, _____________ has since then relin8uishe$ all his rihts,interest an$ participation over the afore$escribe$ parcel of lan$ in favor of thelate _____________ an$ his heirs.

7o%ever, it has co#e to #y *no%le$e that _____________ is presentlyclai#in to still have an interest over the afore#entione$ parcel of lan$ an$ isatte#ptin to sell or $ispose of the sa#e $espite the fact that he has alrea$y

conveye$ all his rihts an$ interests thereon to _____________ an$ his heirs.

0hat unless an a$verse clai# is annotate$ on the afore$escribe$ 0ransferCertificate of 0itle, the heirs of _____________ are in $aner of bein$efrau$e$ an$ $eprive$ of their 4ust an$ vali$ riht over the afore$escribe$parcel of lan$ an$, as such, I a# executin this ffi$avit in support of #yre8uest for the annotation of an a$verse clai# over the parcel of lan$$escribe$ herein.

!;R072R !!I+0 S=207 +;<70.

I+ 9I0+2SS 972R2(!, I have hereunto set #y han$ this _____________,in the City / Municipality of _____________, Philippines.

7/21/2019 55600249 Sample Adverse Claim

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 ffiant

":;R0)