REPUBLIC OF THE PHILIPPINES) Province of Davao del Norte) ______________ ) X . . . . . . . . . . . . .

X REQUEST FOR CANCELLATION OF APPROVED SURVEY PLAN I , Filipino, single and a resident of Magugpo, Tagum City, Davao del Norte, after having been duly sworn to in accordance with law do hereby depose and say : That I am one of the owners of parcels of land identified as ____________________, and covered by TCT No._______________, situated in ___________________________. That my co-owners on the said property have appointed me to represent them, on their behalf, on matters regarding the subdivision of our property. That we manifest our request to the Land Management Section of the Department of Environment and Natural Resources for the cancellation of Subdivision Survey Plan __________________ to give way for the submittal of a new Subdivision Survey Plan that will be submitted. That I am executing this affidavit freely and voluntarily to appraise duly constituted authorities on the facts and circumstances related to subdivision of said Lots. IN WITNESS WHEREOF, I have hereunto set my signature this ___________

______________ Affiant SUBSCRIBED AND SWORN to before me this ______ day of ________, at ________________________, Philippines, the Affiant exhibiting to me her Community Tax Certificate No.______________, issued on ____________, _____, at Tagum City, Davao Del Norte.

_________________ Notary Public Doc. No. ________ Page No. ________ Series of _______