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
described below that if it has no existing improvements whatsoever as of ____________
duly verified by them. (date of sale)

TCT No. Tax Declaration Classification Area FMV/TD

No.
________ _______________ ____________ ______ ___________

IN WITNESS WHEREOF, we have hereunto set our hands this ______ day of
___________________ 2020 in Urdaneta City, Pangasinan.

_____________________________
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 _________ 2020

in Urdaneta City, Pangasinan.

Notary Public

Doc No.: ____

Page No.: ____
Book No.: ____
Series of 2020.