REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

AFFIDAVIT OF ADVERSE CLAIM

I, JUAN DELA CRUZ, of legal age, Filipino, single and a resident of 123 Dimaquita Road,
City of Manila, after having been duly sworn to in accordance with law, depose and state:
1. That on February 14, 2017, I have entered into a Contract to Sell, which was
acknowledged on the same date before Notary Public Pedro Penduco of city of Manila and
entered in his Notarial Register as Doc. No. 76, Page 5, Book VII, Series of 2017. A copy of the
said Deed is hereto attached as ANNEX “A” and made an integral part of this Affidavit;
2. That in the said Contract to Sell, I was the VENDEE of a certain parcel of land covered
by Transfer Certificate of Title No. 98765, more particularly described as follows: (Technical
Description of Property)
3. That because I still have a balance on the purchase price in the amount of P250,000.00,
which is payable within six (6) months from the date of signing thereof, it was stipulated in the
aforementioned Contract 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 Contract to Sell agreed that upon its execution, said
Contract shall be annotated in the Title with the Office of the Register of Deeds of Manila;
5. However, since the said Contract to Sell per se could not be annotated on the Title with
the Office of the Register of Deeds, I am therefore executing this Affidavit for the purpose of
attesting to the 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 the Transfer Certificate of Title
No. 98765.
IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of February 2017
in Manila, Philippines.

JUAN DELA CRUZ

Affiant

(JURAT)