Republic of the Philippines

Department of Environment and Natural Resources

Community Environment and Natural Resources Office
Culasi, Antique

JOINT AFFIDAVIT IN SUPPORT OF APPLICATION FOR FREE PATENT

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ANTIQUE )S.S .
MUNICIPALITY OF CULASI )
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We, JIMMY A. SUMUGAT married to SILVERIA SUMUGAT and JORGE D. SALVAN married to
ALITA LOMUGDANG SALVAN born Filipinio of legal age, residents of Brgy. Fe, Culasi Province of
Antique, Philippines after having been sworn to in accordance with law hereby depose and say:

1. That, we personally know _________________________________________who has filed Free

Patent Application No. _________for a tract of Land located in the Barangay of FE, Municipality of Culasi,
Province of Antique, Philippines;

2. That, we are actual residents of the said Municipality of ________________________________

and we know the land applied for very well;

3. That, the said application has continuously occupied and cultivated the land for himself/herself
and/or that of his/predecessors-in-interest since June 12, 1945 or prior thereto and is free from claims and
conflicts;

4. That, we are not related to the applicant either by consanguinity or by affinity and we are not
personally interested in the land application for , nor in the granting of patent; and

5. That to the best of our knowledge, belief and information, the applicant is a natural born citizen
of the Philippines and is not the owner of more than 12 hectares of land in the Philippines.

IN WITNESS WHEREOF, we have hereunto set our hands and signed this affidavit this _____day
of ________, 20__ in the Municaplity of Culasi, Province of Antique, Philippines.

Res. Cert No. Res. Cert No.

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