TO : THE REGISTRY OF DEEDS

Butuan City

ADVERSE CLAIM
On
that parcel of land covered
by TCT no. T-29248,
situated in Bonbon, Butuan City

We, MARIA VICTORIA SY AMPLAYO AND JOEL

BERNALDEZ, of legal age, , Filipinos and
resident of Tubay, Agusan del Norte, UNDER OATH,
hereby depose and state –

1. That we acquired in good faith and for

value, by way of installments, a 400
square meter (more or less) portion of that
parcel of land situated in Bonbon, Butuan
City, embraced under TCT no. T-29248, from
the titleholder.

Attached hereto is the Deed evidencing that

conditional purchase, marked as ANNEX “A”.

2. That we have paid the downpayment (Php,

10,000.00) and a total of 6 monthly
installments, for a total of Php.
70,000.00.

Attached hereto is the proof of payments,

marked as ANNEX “B”.

3. That in order to protect my interest, I

deem it necessary to interpose this adverse
claim of ownership over that 400 square
meter (more or less) portion of that parcel
of land situated in Bonbon, Butuan City,
embraced under TCT no. T-29248.
 4. I respectfully request the Registry of
Deeds of Agusan del Norte to register the
foregoing adverse claim in its registry and
to annotate the same in TCT no. T-29248.

5. We hereby authorize VICTORIANO SY AMPLAYO

and ANNALIZA SULAPAS to do all acts
necessary for the registration of this
Adverse Claim.

6. I execute this Affidavit to attest to the

truth of the foregoing.

IN WITNESS WHEREOF, I hereunto affix my

signature this ______________________________ at
Butuan City, Philippines.

MARIA VICTORIA SY AMPLAYO

ID ______________________

AND JOEL BERNALDEZ

ID _____________________

SUBSCRIBED AND SWORN TO BEFORE ME, this

____________________________________ at Butuan
City, Philippines.