Republic of the Philippines )

CITY OF ZAMBOANGA …) S. S.
X---------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

That we, __________________, of legal age, _____________, Filipino citizen and a residence of
_____________________, Zamboanga City, Philippines., after having been sworn in accordance with
law, do hereby depose and say:

That We are the heirs of the late Spouses, __________________________________, which

previously entered into a Deed of Absolute Sale for a sale of a portion of a certain parcel of land more
particularly known as, Lot _______, Psd-09-____________, being a portion of Lot __________, Psd-
09-______________, situated at ______________________, Zamboanga City, Island of Mindanao,
containing an area of _____________________________________ (____________) square meters,
covered in and described by Transfer Certificate of Title No. _______________ by the register of deeds
for the City of Zamboanga. A copy of the said Deed is hereto attached as ANNEX “A” and made an
integral part of this Affidavit;

However, it has come to our knowledge that the seller of the said lot ______________________
is refusing to surrender the land title and is presently claiming to still have an interest over the
aforementioned parcel of land despite the fact that he has already conveyed all his rights and interests
thereon to our late parents ______________________ and their heirs.

That unless an adverse claim is annotated on the aforedescribed Transfer Certificate of Title, the
heirs of ________________________ are in danger of being defrauded and deprived of their just and
valid right over the aforedescribed parcel of land and, as such, we are executing this Affidavit in support
of our request for the annotation of an adverse claim over the parcel of land described herein.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, we have hereunto set our hand on this __ th day of ________, 201__
in the Zamboanga City, Philippines.

______________________ _______________________ _______________________ _____________________ _______________________

Affiant Affiant Affiant Affiant Affiant
ID/CTC# _________ ID/CTC# __________ ID/CTC#__________ ID/CTC#__________ ID/CTC#____________
Issued on _________ Issued on __________ Issued on __________ Issued on _________ Issued on ___________
At Zambo. City. At Zambo. City At Zambo. City At Zambo. City At Zambo. City

SUBSCRIBED AND SWORN to me on this __th day of ________, 201__ in the City of
Zamboanga, Philippines.

Doc. No. _______

Page. No. _______
Book No. _______
Series of 201__