(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)