PRLD.ACPN.005.

00
Republic of the Philippines
Office of the President
HOUSING AND LAND USE REGULATORY BOARD
Lupong Nangangasiwa sa Pabahay at Gamit ng Lupa
Northern Luzon Regional Field Office - Baguio City

Republic of the Philippines )

_____________________ ) S. S.

AFFIDAVIT

I, _________________________________ of legal age, single/married with residences

and postal address at ___________________________________________ after being sworn
to in accordance with law hereby depose and say:

1.) That I am the of ________,

owner/developer of located at
_____________________________________________________________.

2.) That we have a pending application for Certificate of Registration and License to
Sell for the abovementioned project.

3.) That to the best of my knowledge, there is no other project under such name under
Presidential Decree No. 957 and Executive Order No. 648.

4.) That in the event that a project exist, located in the same province as our project and
is registered with the HLURB or with the NHA under a name similar to our proposed
name; we are willing to recognize its prior right over and above our application.

5.) That I am executing this affidavit to signify our willingness to change the name of
our proposed project to another name so as not to effect the vested rights and/or
interest of the previous registered project.

AFFIANT FURTHER SAYS NOTHING

_____________________________________, ______________________, Philippines.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of _________, 20___, Affiant
exhibiting to me his/her Residence Certificate No.__________ issued in ___________ on
____________.

NOTARY PUBLIC
Doc. No. : _______
Page No. : _______
Book No. : _______
Series of : _______