REEPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC . . . . . . . . .) S.S

CITY OF TARLAC . . . . . . . . . . . . . .)

AFFIDAVIT OF REQUEST

I, ____________________________, of legal age, married to

_________________________, Filipino citizen, and a resident of
_____________________________________________, after having been duly
sworn to in accordance with law, do hereby depose and state – THAT:

1. I am the registered owner of a parcel of land situated in the

________________________________ with an area of
________________________________ and embraced by Transfer
Certificate of Title No. ________________________;

2. That I have cause the consolidation-subdivision of the above-mentioned

parcels of land into _______________ (___________) SUBLOTS as per
_____________________________ duly approved by the DENR San
Fernando Pampanga on _______________________________;

3. That I hereby request the Registry of Deeds for the Province of Tarlac to
issue separate title for the resulting sublots in my name after the payment of
the required fees, thereof.

IN WITNESS WHEFEOF, I have hereunto set my hand this _____________, at

Tarlac City, Philippines.

_______________________________
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for and in the
Province of Tarlac, this ____________ day of _____________, at Tarlac City.
Philippines.

WITNESS MY HAND AND SEAL.

Doc No. ____________ ;

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