CARPER LAD Form No.

70-H

Republic of the Philippines

DEPARTMENT OF AGRARIAN REFORM
Province of Samar
Region No. VIII

REQUEST FOR PARCELIZATION OF

COLLECTIVE CERTIFICATE OF LANDOWNERSHIP AWARD (CCLOA)

____________________________________
DATE

The Municipal Agrarian Reform Program Officer (MARPO)*

DAR Municipal Office
Basey, Samar

Sir/Ma’am:

The undersigned Agrarian Reform Beneficiaries (ARBs) hereby request for the parcelization of
the landholding covered by a CCLOA in the name of __________________________________
(ARB cooperative/association or other forms of collective organization) and described as
follows:

CCLOA Serial No. : 00017001

OCT/TCT No. : CLOA 35
Lot No. : 1535
Approved Survey No. : Psd-08-033633-D(AR)
Total Area (sq. m.) : 57,075
Total ARBs : 15
Location of Property : Brgy. Bulao, Basey, Samar

The request for parcelization of the said landholding and the subsequent of individual CLOA are
due to the following:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Attached are the pertinent documents to support our request/petition for parcelization:

_____/ Owner’s Duplicate Copy (ODC) of CCLOA

_____/ Proof of Identification/s

*Note: In DAR Provincial Offices without DAR Municipal Offices/Municipal Agrarian Reform
Program Officers, the request will be addressed to the Provincial Agrarian Reform Program
Officer II (PARPO II)
_____/ Copy of Petition for the Re-issuance of ODC by:
 DAR, if ODC lost by DAR
 ARB/Cooperative/Association/Other Forms of Farmer’s Collective
Organization, if ODC was lost by either of the same group

_____/ Sworn Undertaking Agreement executed by the applicants/ARBs that they are
owners, consenting to the parcelization/subdivision of the subject CCLOA to pay
for the cost and other fees incurred related to the subdivision/parcelization survey;

_____/ Registry of Deeds (ROD) – certified true copy of CCLOA subject for
subdivision/parcelization.

Thank you.

Respectfully yours,

Names of ARBs Included in the

Signature
Existing CLOA
Guillermo E. Abebuag
Roger P. Abebuag
Diorico M. Avila
represented by daughter
Anacorita Orguino Nympha O. Jadloc
Letecia B. Jadloc
represented by son
Remedios R. Abebuag Roger R. Abebuag
X – NOTHING FOLLOWS

(USE ADDITIONAL SHEETS IF NECESSARY)

Copy Distribution:

Original - MARPO
Duplicate - PARPO
Triplicate - ARB/Cooperative/Organization/Association
 CARPER LAD Form No. 70-H

Republic of the Philippines

DEPARTMENT OF AGRARIAN REFORM
Province of Samar
Region No. VIII

REQUEST FOR PARCELIZATION OF

COLLECTIVE CERTIFICATE OF LANDOWNERSHIP AWARD (CCLOA)

____________________________________
DATE

The Municipal Agrarian Reform Program Officer (MARPO)*

DAR Municipal Office
Basey, Samar

Sir/Ma’am:

The undersigned Agrarian Reform Beneficiaries (ARBs) hereby request for the parcelization of
the landholding covered by a CCLOA in the name of __________________________________
(ARB cooperative/association or other forms of collective organization) and described as
follows:

CCLOA Serial No. :

OCT/TCT No. :
Lot No. :
Approved Survey No. :
Total Area (sq. m.) :
Total ARBs :
Location of Property :

The request for parcelization of the said landholding and the subsequent of individual CLOA are
due to the following:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Attached are the pertinent documents to support our request/petition for parcelization:

_____ Owner’s Duplicate Copy (ODC) of CCLOA

_____ Proof of Identification/s

*Note: In DAR Provincial Offices without DAR Municipal Offices/Municipal Agrarian Reform
Program Officers, the request will be addressed to the Provincial Agrarian Reform Program
Officer II (PARPO II)
_____ Copy of Petition for the Re-issuance of ODC by:
 DAR, if ODC lost by DAR
 ARB/Cooperative/Association/Other Forms of Farmer’s Collective
Organization, if ODC was lost by either of the same group

_____ Sworn Undertaking Agreement executed by the applicants/ARBs that they are
owners, consenting to the parcelization/subdivision of the subject CCLOA to pay
for the cost and other fees incurred related to the subdivision/parcelization survey;

_____ Registry of Deeds (ROD) – certified true copy of CCLOA subject for
subdivision/parcelization.

Thank you.

Respectfully yours,

Names of ARBs Included in the

Signature
Existing CLOA
Guillermo E. Abebuag
Roger P. Abebuag
Diorico M. Avila
represented by daughter
Anacorita Orguino Nympha O. Jadloc
Letecia B. Jadloc
represented by son
Remedios R. Abebuag Roger R. Abebuag
X – NOTHING FOLLOWS

(USE ADDITIONAL SHEETS IF NECESSARY)

Copy Distribution:
Original - MARPO
Duplicate - PARPO
Triplicate - ARB/Cooperative/Organization/Association