Form No.

12- Conveyance in payment of subscription to capital stock of proposed corporation

DEED OF CONVEYANCE

KNOW ALL MEN BY THESE PRESENTS:

This DEED, made and executed by and between (Name of subscribing stockholder),
single/widower/married to .............................................., of legal age,..........................citizen, and a
resident of ................................., hereinafter called the APRTY OF THE FIRST PART, and (Name of
Treasurer), single/widower/married to ....................................., of legal age, ............................ citizen,
and with residence and postal address at ............................................, in his capacity as TREASURER of
the proposed corporation named ".....................................," with principal office to be established or
located at..............................................., hereinafter called the PARTY OF THE SECOND PART,

WITNESSETH:

FIRST.- That the PARTY OF THE FIRST PART is the owner in fee simple of that/those certain parcel/s of
land with all improvements existing thereon, situated in the ................................................, and more
particularly described as follows:

(Description of Property)

his/her title thereto being evidenced by Transfer/Original Certificate of Title No. ........................., issued
by the Registrar of Deeds of ....................................;

SECOND.- That the PARTY FOR THE SECOND PART hereby certifies and states under oath that the said
proposed corporation has the constitutional or legal qualifications and requisites for acquiring or holding
public or private agricultural lands in the Philippines, and not less than sixty per centum (60%) of the
capital stock thereof is or shall be owned by citizens of the Philippines.

THIRD.- That in consideration of the subscription of the PARTY OF THE FIRST PART for ............................
shares of the capital stock of the proposed corporation, which subscription is of the total value
of ............................................ Pesos (P..................) at par, and as partial (or full) payment in the amount
of ...................................)upon account of said PARTY OF THE FIRST PART has transferred, conveyed, and
assigned, and by these presents does transfer convey, and assign in trust unto the PARTY OF THE
SECOND PART, which party hereby acknowledges to have received for the benefits and to the credit of
the corporation, in accordance with Section 9 of the Corporation Law, as amended, all the rights, titles
and interests of the PARTY OF THE FIRST PART in and to the property above described; and

FOURTH.- That is hereby agreed that in case the Article of Incorporation of the said proposed
corporation cannot, for any reason or reasons, be duly registered is rejected by, the Securities and
Exchange Commission, then this deed of conveyance shall be null and void and thereupon the PARTY OF
THE SECOND PART shall execute another deed conveying the property above described to the PARTY OF
THE FIRST PART.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands at .........................................,
Philippines, on this ..................day of................., 20............

................................................... ............ ......................................

Party of the First Part Party of the Second Part
TIN- TIN-

WITH MY MARITAL CONSENT:

............................
(Wife or Husband of Vendor)
TIN-

SIGNED IN THE PRESENCE OF:

........................................................................................................................................................................
(Notarial Acknowledgment with oath inserted)