REPUBLIC OF THE PHILIPPINES)

Marikina City………………………………) S.S.

x--------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, ________________________, of legal age, Filipino, married ,and aresident of

_____________________, after having been sworn to in accordance with law, depose
and say:

1. That I am one of the heirs of the late ____________________________

who died last ______________________;

2. That a certain _____________ previously entered into a Deed of

Conditional Sale with the(Government Service Insurance System(GSIS) or
Pag-IBIG)for the purchase of a parcel of land (including the improvements
thereon) located at Midtown, Marikina City , more particularly described as
follows:

(Property)

3. That on _____________ , _____________ executed a (Deed of Transfer

of Rights / Assumption of Obligations)in favor of the late _____________ ,
which document is more particularly identified asDocument No. ______ ,
Page No. ______ , Book No. ______ , Series of ______ in the Notarial
Register of Notary Public _____________ and acopy of which is attached
herein.

4. That in said(Deed of Transfer of Rights / Assumption of Obligations),

_____________ , for valuable consideration received,
CEDED,TRANSFERRED AND CONVEYED to _____________ , his
heirs, successors and/or assigns, all his rights, interest and participation
inthe purchase of the aforedescribed parcel of land.

5. That as such, _____________ has since then relinquished all his

rights,interest and participation over the aforedescribed parcel of land
infavor of the late _____________ and his heirs.

6. However, it has come to my knowledge that _____________ is

presentlyclaiming to still have an interest over the aforementioned parcel
of land and is attempting to sell or dispose of the same despite the fact
that he has already conveyed all his rights and interests thereon to
_____________ and his heirs.

7. That unless an adverse claim is annotated on the aforedescribed Transfer

Certificate of Title, the heirs of _____________ are in danger of being
defrauded and deprived of their just and valid right over the
aforedescribed parcel of land and, as such, I am executing this Affidavit in
support of my request for the annotation of an adverse claim over the
parcel of land described herein.

IN WITNESS WHEREOF, I have set my hand this ______________ in Marikina

City, Philip
 _________________________________
AFFIANT

SSS I.D. No. _________________________

Issued at Marikina City

SUBSCRIBED AND SWORN to before me, this _______________ by the Affiant

whom I have identified through competent evidence of identity and who exhibited her
Government Issued Identification Number as per description appearing below her name.

Doc No.: _____;

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