CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS WILL CERTIFY THAT the segregation and subdivision survey of the hereunder described
properties covered by Module No. ________ have been duly executed and completed by ____________,
to wit;

Name of
Title/ TD No. Area (has.) Location Land Type Land Size
Landowner

Further certifies that the resultant segregation and subdivision lots have been duly and
completely monumented, survey profile had been validated and confirmed to be true and correct and
that subject properties are not covered by on-going, pending and approved surveys.

Further certifies that this office will no longer request any corrections, amendments, and/or any
kind of changes in the approved plan of the above subject landholdings as the same were already
thoroughly reviewed/validated by the undersigned. However, this is certification does not apply to
technical errors that may be noted later after the approval of the segregation/subdivision survey and
request for changes shall be made within 15 days upon receipt of the ASP.

Issued this _______ day of ___________________, 2017 at Department of Agrarian Reform

Provincial Office, Nursery, Masbate City.

___________________________
MARPO

Noted: With my Concurrency:

FELIX E. FRUTO __________________________

PARPO II DAR GE (DARPO)