Republic of the Philippines ]

City of Tagbilaran ] S.S.

AFFIDAVIT
(ATTESTING THAT NO CERTIFICATE OF TITLE WAS RECEIVED)

WE, the Heirs of __________________., namely: _______________________, all

Filipinos, of legal ages, and residents of _______________________, Philippines, after being
duly sworn in accordance with law, hereby depose and say, that:

1. That years ago, __________________________ submitted a Free Patent Application

together with its supporting documents to the DENR covering a parcel of land designated
as Lot No. ________ situated in ____________________________, Philippines,
containing an area of _______________________ (_________) SQUARE METERS,
more or less;

2. That ___ died on ____________ at __________________, Philippines;

3. That up to date, we have not received a Certificate of Original Title / Free Patent
concerning the above application;

4. That we execute this affidavit voluntarily to attest to the truth of the foregoing statements,
to request for the issuance of Certificate of Original Title / Free Patent covering the said
property, and for whatever legal purpose this may serve.

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

______________________, Philippines.

________________________ _______________________________
Affiant Affiant
Valid ID: ______________ Valid ID: ______________

SUBSCRIBED AND SWORN to before me this _______________ at Tagbilaran City,

Bohol, Philippines.

Doc. No. ________;

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