Republic of the Philippines

Court of First Instance of _________________

The undersigned, ____________________________________________________________hereby

applies (or apply) to have the land hereinafter described brought under the operation of the Property
Registration Decree, and to have the title thereto registered and confirmed:

AND DECLARE . . . . .

1. That the applicants/s is/are the owners of the land (by virtue of inheritance or deed of sale or
conveyance and/or possession in accordance with Section 14 of said Decree), together with the building
and improvements thereon, with the exception of the
following:__________________________________________________________________ which is/are
the property of _________________________ residing at _________________________ The said land,
consisting of ____________________ parcel/s is/are situated, bounded and described as shown on the
plan and technical descriptions attached hereto and made a part hereof, with the following
exception:___________________________________________________________________

2. That said land at the last assessment for taxation was assessed at P ____, Philippine currency, and the
buildings and other improvements at P ___________, Philippine currency.

3. That to the best of my/our knowledge and belief, there is no mortgage or encumbrance of any kind
whatsoever affecting said land, nor any other person having any interest therein, legal or equitable, or in
possession, other than as follows:
_______________________________________________________________________________

4. That the applicant/s has/have acquired said land in the following manner:
________________________________

(Note: Refer to Sec. 14 of said Decree. State also whether the property is conjugal, paraphernal or
exclusive property of the applicant/s)

5. That said land is occupied by the following person: _____________________________

______________________________________________

6. That the names in full and addresses, as far as known to the undersigned, of the owners of all
adjoining properties, of the persons mentioned in paragraphs 3 and 5, and of the persons shown on the
plan as claimants, are as follows:
_____________________________________________________________________________________
___

7. That the applicant/s is/are single or married to ____________________ (Note: if marriage has been
legally dissolved, state when and how the marriage relation
terminated.)_________________________________________________________________
_____________________
8. That the applicant's/s' full name, age, citizenship, residence, and postal address/es is/are as follows:
___________________________________________________________________

9. That (Note: If the land included in the application is bounded by a public or private way or road, there
should be stated in this paragraph whether or not the applicant claims any and what land within the
limits of the way or road and whether the applicant desires to have the line of the way or road
determined.) ________________________________________ ___________________________

10. That the following documents are attached hereto and made a part hereof:
___________________________________ ________________________________

Signed at ___________________ this _____________________ day of ____________________, in the

year nineteen hundred and ______________________.

__________________________
Applicant

_________________________
(Post Office Address)

REPUBLIC OF THE PHILIPPINES

PROVINCE (OR CITY) OF _______________

On this _______________ day of _________________________,19 ________ personally appeared

before me the above- named __________________________________________________ known to
me to be the person/s who executed the foregoing application and made oath that the statements
therein are true of his/their knowledge, information and belief.

The Residence Certificate/s ______________________ of the applicant/s ______________ was/were

exhibited to me being No. _________________ issued at ___________________ dated ____________,
19 __________.

________________________

(Notary Public, or other Officer

authorized to administer oaths)

PTR NO. _________________