HLURB MC No.

Series of 200____
Annex ____

Republic of the Philippines )

______________________ ) S.S.

AFFIDAVIT
(Owner)

I, __________________________ of legal age, single/married with residences and postal address

at ____________________________________________________ after being sworn to in accordance
with law hereby depose and say:

1) That I am the ____________________________, of ____________________________________

(State Position) (State Name Corporation/Partnership)
_______________________ owner/developer of _____________________________________
located at ______________________________________________________________.

2) That the said property/ies is/are to be mortgaged with ___________________________________;

(State Name of Bank/Financial Institution)

3) That I shall notify the lot/unit buyers of the mortgage loan and that they shall be allowed to make
direct payments to the mortgagee bank in the event that I default in my amortization to enable the
said buyers to obtain title on the lot/unit promptly after full payment, thereof;

4) That the proceeds of the loan shall be used exclusively for the development of the _____________
____________________________________________;
(Name of Subdivision/Condominium Project)

5) That I am executing this affidavit for and in behalf of abovestated corporation/partnership attesting
to the facts stated therein to comply with the requirements of the HLRB and for all legal intents
and purposes.

AFFIANT FURTHER SAYS NOTHING.

_______________________________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of _______________ 200___, affiant
exhibiting before me his/her Residence Certificate No. ___________________________ issued at
______________________ on ___________________________.

Doc No.
Page No.
Book No. NOTARY PUBLIC
Series of 200___