REPUBLIC OF THE PHILIPPINES )

) S.S.
x ------------------------------------------ x

AFFIDAVIT OF AGGREGATE LANDHOLDINGS

I, __________________________, __________, of legal age, _________ and a resident of Barangay

______________________________, represented herein by my Attorney-in fact ___________________,
Filipino of legal age, married and resident of _______________________, by virtue of Special
Power of Attorney executed on _________________ at __________ before ___________________, a Notary
Public for and in the City of __________________, registered in his/her Notarial Book as Doc. No.
____, Page No. ____, Book No. ____, Series of 20___, after having been duly sworn to, in
accordance with law, hereby depose and say;

That I am the owner of one parcel of land which I transferred to

__________________________________________, known as Lot No. ___________, Survey No. ____________
situated in Brgy. _____________, ___________________ covered by Original/Transfer Certificate of
Title No. _________, containing an area of ________________________________________________ SQUARE
METERS (_____ sq.m.), more or less;

That I do not own other agricultural land in the City of _________________, within the
_____________ or anywhere else in the country in excess of five (5) hectares.

That I am executing this Affidavit in compliance with the rules and regulations of the
Department of Agrarian Reform (DAR).

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ day of

________________, 20_________ at, __________________________________.

______________________
Affiant
Represented by:

Attorney-in-fact

SUBSCRIBED AND SWORN TO BEFORE me, this _____ day of __________________,

20_______ at ________________________, affiant exhibiting to me his/her government issued
identification ___________________________________ issued on ____________________ by
_________________________, bearing his/her photograph and signature.

Notary Public
Doc. No. __;
Page No. __;
Book No. __;
Series of 20__.