Republic of the Philippines)

x---------------x

AFFIDAVIT OF ADVERSE CLAIM

I, _____________, of legal age, Filipino, single, and a resident of

_____________, after having been sworn to in accordance with law, depose
and say:

1. That I am one of the heirs of the late _____________ who died on

__________ in ____________________.

2. That a parcel of land located at _____________, registered under

the name of _______________ more particularly described as
follows:

(Technical Description of Property)

3. It has come to my knowledge that abovementioned parcel of land

was extra-judicially settled without my participation.

4. That unless an adverse claim is annotated on the abovementioned

Transfer Certificate of Title No. _______, I am in danger of being
defrauded and deprived of their just and valid right over the
abovementioned parcel of land and, as such, I am executing
this Affidavit in support of my request for the annotation of
an adverse claim over the parcel of land described herein.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________, in the City / Municipality of _____________, Philippines.

Affiant