Republic of the Philippines )

Done in the City/ Province of ____)S.S.

AFFIDAVIT OF ADVERSE CLAIM

I, __________________________, of legal age, Filipino Citizen, single with
residence at ______________________, after having been duly sworn to in
accordance with law hereby depose and state that:

1. Personal circumstances of the affiant;

2. Facts __________________;
3. ______________________________
TRANSFER CERTIFICATE OF TITLE NO. 018-2020001588

I am executing this affidavit for the purpose of attesting to

the truthfulness of the foregoing allegations and in support of my
request for the annotation of an adverse claim over the parcel of
land and the two-storey house covered by Transfer Certificate of
Title No. 018-2020001588.

IN VIEW OF THE FOREGOING, I have hereunto set my hands this ___

day of August 2021 at _________________ Philippines.

__________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this __ day of August 2021

at ______________,

WITNESS MY HAND AND SEAL this ____ day of August 2021 at ______

Notary Public
Doc No. _____;
Page No. ____;
Book No. ____;
Series of 2021