Republic of the Philippines ]

City of Tagbilaran ] S.S.

AFFIDAVIT OF OWNERSHIP

We, ___________________________ and ___________________________, both

Filipinos, of legal age, and residents of _____________________, Philippines, after being duly
sworn in accordance with law, hereby depose and say:

1. That we / our deceased ancestor _________________ cultivated and possessed a parcel

of land situated at _________________ designated as Lot No. _____________;

2. That we / our ancestor took possession over this lot for more than thirty (30) years which
possession is open, public, and peaceful;

3. That we / our ancestor have/has cultivated this lot from the time he took possession of the
same;

4. That there is no existing ownership or boundary dispute concerning the said lot;

5. That we take the responsibility if any case may arise or anyone may claim ownership
over the same.

IN WITNESS WHEREOF, we hereunto set our hands this _________________ at

Tagbilaran City, Bohol, Philippines.

_______________________________ _______________________________
Valid ID: Valid ID:

Attested by:
______________________________________
Barangay Official, __________________

SUBSCRIBED AND SWORN to before me this _______________ at

________________________, Philippines.

Doc. No. ________;

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