REPUBLIC OF THE PHILIPPINES)

CITY OF __________) S.S.

X-------------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, _______________________________________, of legal age, Filipino, ____________,

and presently residing at _____________________________________________________,
after having been duly sworn to in accordance with law, depose and
state:
1. That on July 10, 2013, I have entered into a Deed of Conditional
Sale which was acknowledged on the same date before Notary
Public Juan Tamad of Makati City and entered in his Notarial
Register as Doc. No. 2, Page 2, Book II, Series of 2013. A copy of the
said Deed is hereto attached as ANNEX “A” and made an integral
part of this Affidavit;
2. That in the said Deed of Conditional Sale, I was the VENDEE of a
certain parcel of land covered by Transfer Certificate of Title No.
111222, more particularly described as follows:
(Technical Description of Property)
3. That because I still have a balance on the purchase price in the
amount of P500,000.00 which is payable within one (1) (year)
from the date of signing thereof, it was stipulated in the
aforementioned Deed that title and ownership over the subject
property will only be transferred upon full payment of the same;
4. That the VENDOR in the said Deed of Conditional Sale agreed that
upon its execution, said Deed shall be annotated in the Title with
the Office of the Register of Deeds of Makati City;
5. However, since the said Deed of Conditional Sale per se could not
be annotated on the Title with the Office of the Register of Deeds, I
am therefore executing this Affidavit for the purpose of attesting
to the truthfulness of the foregoing allegations and in support of
my request for the annotation of an adverse claim over the parcel
of land covered by the Transfer Certificate of Title No. 111222.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
__________ 20____ in ____________, __________, Philippines.
 _______________________________________
Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of _________ at

________________ affiant exhibited to his/her competent evidence of
identity by way of _________________ issued on ____________ ____, 20____ and
valid until ____________ ____, 20____ in _______________, Philippines.

Notary Public

Atty. _________________________________________
Notary Public for ____________
Appointment No. ____ Until _________ 20____
Roll of Attorney No. _________
PTR No. _________ IBP No. _________
MCLE Compliance No. _________

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 20___.