Republic of the Philippines )

__________________________) S.S.

AFFIDAVIT OF ADVERSE CLAIM

I, RRR, of legal age, Filipino citizen, single and a resident of #244 A Mabini St.,
Poblacion 2, Indang, Cavite, after having been sworn to in accordance with law, do
hereby depose and state that:

1. On December 2, 2019, I have entered into a Deed of Conditional Sale with a

certain BBB which was acknowledged and notarized on the same date before
Notary Public Atty. PPP and entered in his Notarial Book and docketed as Doc.
No. 1; Page No. 1; Book No. 1 and Series of 2019. A copy of said Deed is
attached herewith and made an integral part hereof for easy reference;

2. In the said Deed of Conditional Sale, I was the VENDEE/BUYER of a certain

parcel of land covered by Transfer Certificate of Title (TCT) No. 057-919191 of
the Registry of Deeds for the Province of Cavite and more particularly described
as follows:

TCT No. 057-919191

“ Enter technical description

3. Considering that I still have a balance on the purchase price in the amount of
TEN THOUSAND PESOS (Php10,000.00) which is payable within Four (4)
months from the date of the signing thereof, it was stipulated in the
aforementioned Deed that the title and ownership over the subject real property
will only be transferred upon full payment of the same;

4. Consequently, the VENDOR/SELLER in the said Deed agreed that upon

its execution, the subject Deed of Conditional Sale shall be annotated in the
Title with the Office of the Registry of Deeds for the Province of Cavite;

5. However, since the said Deed per se could not be annotated on the Title with
the said government office, I am therefore executing this Affidavit for the
purpose of attesting to the truthfulness of the foregoing averments, in support
of my request for the annotation of an adverse claim over the above-described
real property and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature this
_______ day of ________ at _____________________.

RRR
Affiant

SUBSCRIBED AND SWORN to before me, this ______ day of _________ at

______________, by the affiant whom I have identified through his ____________ issued
at ________________, which serves as his Competent Evidence of Identity pursuant to
the 2004 Rules on Notarial Practice.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2019.