Republic of the Philippines)

City of Santiago
)SS.
x- - - - - - - - - - - - - - - -x

AFFIDAVIT OF ADVERSE CLAIM

I, ____________________________, of legal age, Filipino, single and a resident
of _________________________, after having been duly sworn to in accordance with law,
depose and state, THAT:
1. On

_______________________, I

which

was

acknowledged

have entered into

on

the

a Deed of Conditional Sale

same

date

before

Notary

Public ____________________ of Santiago City and entered in his Notarial Register

as Doc. No. ___, Page___ Book ____, Series of 20___. A copy of the said Deed is
hereto attached as ANNEX A and made an integral part of this Affidavit;
2. In the said Deed of Conditional Sale, I was the VENDEE of a certain parcel of land
covered by Transfer Certificate of Title No. ________________________, more
particularly described as follows:
(Technical Description of Property)
3. That because

still

have

balance

on

the

purchase

price

in

the

amount of _____________ which is payable within one (1) (year) from the
date of signing thereof, it was stipulated in the aforementioned Deed that title
and ownership over

the

subject

property

will

only

be

transferred

upon

full

payment of the same;

4. That the

VENDOR

in

the

said Deed of Conditional Sale

agreed

that

upon

its

execution, said Deed shall be annotated in the Title with the Office of the
Register of Deeds of Isabela;
5.

However, since the said Deed of Conditional Sale per se could not be annotated on
the

Title

with

this Affidavit for

the Office of the

the

Register of Deeds,

purpose of attesting

to

the

am

therefore

executing

truthfulness of the

foregoing

allegations and in support of my request for the annotation of an adverse claim over
the parcel of land covered by Transfer Certificate of Title No. ____________.
IN

WITNESS

WHEREOF,

have

hereunto

set

my

hand

of _____________________ at Santiago City, Philippines.

________________
Affiant

this ___

day

SUBCRIBED

AND

______________ at Santiago
_________________________

SWORN

TO before

City, Philippines,
a

competent

affiant

me

this

exhibiting

evidence

of

____day
to

me

identity,

of

his/her
issued at

_______________________ on ________________ and valid until __________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 20___.