Republic of the Philippines )

Province of Masbate )
____________________ ) S.S.

SWORN UNDERTAKING TO REMAIN AS CO-OWNER OF AWARDED LAND COVERED

BY COLLECTIVE CERTIFICATE OF LAND OWNERSHIP AWARD

I, ___________________, of legal age, Filipino, and a resident of

____________________________________________________, after having been
sworn in accordance with law, hereby depose and state that:

1. I am an Agrarian Reform Beneficiary (“ARB"), having the rights and duties under
Republic Act No. 6657, otherwise known as the Comprehensive Agrarian Reform Law,
as amended;

2. I am named as a registered co-owner of land the agricultural land covered by a

Collective Certificate of Landownership Award (CCLOA) described as CCLOA No.
_________ registered in the name of ______________________, et. al.,
containing an area of __________________ square meters, more or less, with
Lot No. ___________, located in Barangay _________________ ;

3. I opt to remain as a co-owner of the agricultural land that is collectively farmed and
operated in an integrated manner together with the other ARBs named in the above
mentioned certificate of land ownership award pursuant to R.A. No. 6657, as amended
by Section 10 of R.A. No. 9700;

4. Under Section 2.23 of the Department of Agrarian Reform (DAR) Administrative Order
(AO) No. 01 Series of 2021, ARBs of the awarded land covered by a Collective
Certificate of Land Ownership Award CCLOA shall have the right to consent to remain
as co-owners of CCLOA;

5. Likewise, under Section 3.3 of AO. No. 01 Series of 202, some of the ARBs may choose
to maintain the CCLOA while the others may opt to dissociate himself/themselves from
a CCLOA, the same shall be parcelized resulting to a combination of individual c-Titles
and collective c-Titles subject to existing laws and policies of DAR; ARBs of the awarded
land covered by a Collective Certificate of Land Ownership Award CCLOA shall have the
right to consent to remain as co-owners of CCLOA;

6. I am manifesting my choice to remain as co-owner of the said CCLOA, without

prejudice to the right of the other co-owners who opted to be issued an individualized
title;

7. I am executing this affidavit for the purpose of attesting to the truth of the foregoing
facts, with my own free will and without pressure from third persons.

IN WITNESS WHEREOF, I hereunto set my hands this __ day of ___________ 20___

at ______________, Philippines.

__________________________
Affiant
(Signature over printed name)

SUBSCRIBED and SWORN before me this ___ day of ______ 20__ at

______________, Philippines, by the affiant who is personally known to me and to me known
to be the same person who executed the foregoing Affidavit.

Doc. No. ____.

Page No. ____.
Book No. ____.
Series of ____.