LTC Form No. 4 Republic of the Philippines) City/Municipality of 18.5. Province of ) LIC Application No,__ APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCI WE, of legal age, Filipino, married’ single/ widow and resident of __ » and of legal age, Filipino citizens, married’singlelwidow and resident of , afier being sworn in accordance with law, hereby deposes and state: 1. We are the parties in a ct __(Deed of Sale/Donation/Extra-judicial settlement, etc.) involving a parcel of land covered by TCTIOCT No. __ _, with Lot No. fi “(hectares), more oF less, and located at declared under Tax Declaration (TD) No. Survey No. _, with an arca of i This application for the issuance of Land Transfer Clearance (LTC) is not contrary to law because both of us are qualified to dispose and acquire the land described above. In addition, the said fand is neither covered under the agrarian reform program nor within the CARPER AD Balance, and that the deed/contract will not violate the retention limit provided under the law, 3. In support thereto and in compliance with DAR A.O. No. 4, Series of 2021, the mandatory documents are hereto attached and made integral part hercof as (please check appropriate box) 3.1 FOR THE TRANSFERO! [1 Official Receipt ‘Annex__ [J Electronic Copy of the Title and/ or ‘Annex __ ( Certified True copy of Tax Declaration (7] Deed or document to be registerad Annex__ (Affidavit of Aggregate Landholding ‘Annex [J Affidavit of Retention, Non-Tenaney/tenancy with compliance — :Annex of tenant’s right of Pre-emption and/or Redemption, Improvement/no improvement, no pending case before the regular courts or any other tribunal involving the land subject of the transaction, if there is a case before the regular courts or any other tribunal the same had been decided with finality; and xno conflict of claims involving the subject land by the transferee or third person claimant. {_] Municipal Assessor's Certificate of Aggregate Landholding Annex C1 City Assessor's Certificate of Aggregate Landholding ‘Annex, ger i [J Provincial Assessors Certificate of Aggregate Landholding Anmex___ 1}LTC Form No.1 3.2 FOR THE TRANSFEREE: (1 Affidavit of Aggregate Landholding Annex, (7) Municipal Assessor's Certificate of Aggregate Landholding Annex__ (1 City Assessor's Certificate of Aggregate Landholding Annex___ (J Provincial Assessors Certificate of Aggregate Landholding Annex C] Municipal Agrarian Reform Program Officer Certification! ‘Annex, (LTC Form No.2 4, Having submitted/attached hercof the mandatory documents as required under DAR A.O. No. 4, Series of 2021, I/we hereby file this instant application/request to facilitate the issuance of the corresponding Certificate on LTC. IN WITNESS WHEREO! we have hereunto set our hand this at Philippines. ‘Applicant/ ‘Transteror ‘Applicant/Transferee ID No, ID No. Date Issued: Date Issued: Place Issued: Place Issued: SUBSCRIBED AND SWORN to before me this AMffiants upon exhibiting to me their duly issued government [Ds NOTARY PUBLIC Doc No. Book No Page No, Series of 20 Copy Distribution: Original-DARPOILTC Folder Duplicate- Applicant Applicent contact number: