REPUBLIC OF THE PHILIPPINES )

_______________________ ) S.S.
_______________________ )

AFFIDAVIT OF TRANSFEREE

I, _____________, married to ____________, of legal age, and residing in ______________, after having
been duly sworn to in accordance with law, hereby depose and state that:

(1) I am one of the legitimate children surviving heirs of the Late Spouses _________________________;

(2) The Late Spouses having left no will and no debts, I and the other legitimate surviving heirs in the name of
_______________________________________________ agreed to divide and settle the estate, wherein
one of the properties consisting the estate, which is a parcel of cocoland with Original Certificate of Title
Blg. _____ containing an area of ____ square meters is adjudicated in my favor, as evidenced by Extra-
Judicial Partition and Settlement of Estate of the above-named Late Spouses, entered into the notarial
register of Notary Public _____________dated ___________ at ____________ under Doc. No. ____; Page
No. _____; Book No. _____; Series of _____;

(3) I am executing this Affidavit in compliance to Department of Agrarian Reform (DAR) Administrative
Order No. 01-89, as well as to show proof that our total aggregate land holdings inclusive of the afore-
mentioned lot does not exceed five (5) hectares and hence, neither covered by Presidential Decree 27,
Series of 1972 nor the Comprehensive Agrarian Reform Program;

(4) I am executing this Affidavit in support of our application to secure DAR Clearance, and for whatever legal
intents and purposes that it may legally serve.

IN WITNESS WHEREOF, we have hereunto set our hands this ______________ day of
_______________, at Bobon, Northern Samar, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN TO before me this __________________________, at Catarman,

Northern Samar.

WITNESS MY HAND AND NOTARIAL SEAL.

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2021.

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Affidavit of Transferee