REPUBLIC OF THE PHILIPPINES ) S.S.

________________________ )
x---------------------------x

AFFIDAVIT OF TOTAL LANDHOLDINGS

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

__________________________, after having been duly sworn to in accordance with law,
depose and state:

1. That I am the VENDEE of a parcel of land located at Brgy. San Roque, Jaro, Leyte with
an area of ___________________________ (9,723) square meters, more or less,
covered by Original Certificate of Title No. _______;

2. That aside from the above-mentioned parcel of land, I do not own any agricultural
land in Jaro, Leyte or anywhere in the Philippines;

3. That I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal intents and purposes that it may legally serve;

IN WITNESS WHEREOF, I have hereunto set my hand this __________________,

2020 in _________________.

_________________________
Affiant
ID NO: ___________________

SUBCRIBED AND SWORN TO before me this ____________, 2020 in

_________________________, affiant exhibiting to me his valid proof of identification.

Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.