(Deed of Revocation of Donation)

DEED OF REVOCATION OF DONATION

KNOW ALL MEN BY THESE PRESENTS:

That, I, _____________, Filipino, of legal age, (single / married / widow), and a resident of
_____________, Philippines, by virtue of a certain public instrument made and executed on
_____________ at _____________, Philippines, and entered on the Notarial Register of Notary Public
_____________ as Doc. No. ______, Page No. ______, Book No. ______, Series of ______, did voluntarily
and freely give, by way of DONATION, unto _____________, who is also of legal age, Filipino, (single /
married / widow), and a resident of _____________, Philippines (hereinafter referred to as the "DONEE"),
a certain parcel of land more particularly described as follows:

(Technical Description of Property)

WHEREAS, the DONEE undertook to render support to the undersigned DONOR such that the
undersigned then willingly and voluntarily donated the aforementioned parcel of land to the DONEE.

WHEREAS, in an act of ingratitude, the DONEE has refused to, still refuses and continues to refuse
to give support to the DONOR.

NOW, THEREFORE, I, _____________, by virtue of Article 765 of the New Civil Code, do hereby
REVOKE, AVOID, and CANCEL the above-mentioned donation, and demand from said DONEE,
_____________, the immediate reconveyance of title of the above-described property in the name of the
undersigned and turn-over of possession thereof from the date hereof.

_____________, Philippines, _____________, 200__.

DONOR

SIGNED IN THE PRESENCE OF:

__________________ __________________

(ACKNOWLEDGMENT)