Annex D

SWORN DECLARATION OF NO IMPROVEMENT ON REAL PROPERTY

In accordance with Revenue Memorandum Order No. __________ dated ____________, the parties
are executing this sworn statement under penalties of perjury, to attest to the truth of the declaration and for
the purpose of stating the true conditions of the property/ies described below that it/they/ has/have no
existing improvements whatsoever as of ___________________________ duly verified by them.
(date of sale/donation/death of decedent)

TCT No. Tax Declaration No. Classification Area FMV/TD

IN WITNESS WHEREOF, we have hereunto set our hands this _________ day of ___________
2002 in _____________.

_____________________________________
Signature over Printed Name of Transferee

We hereby authorize the Commissioner of Internal Revenue or his duly authorized representative to
verify the above information.

SUBSCRIBED AND SWORN to before me this ________ day of __________, in ______________.

_______________________________
Notary Public/Administering Officer