Republic of the Philippines )

_________________________ )S.S.

AFFIDAVIT OF TRANSFER OF OWNERSHIP

I, ____________________, of legal age, Filipino, after having been duly sworn

to in accordance with law, hereby depose and state:

1. That I am a consumer/customer of _____________ WATER DISTRICT with

Account No. _________________ registered under my name;

2. That, after complying with the formalities required by law, I decided to sell and
eventually sold the house and lot located at
______________________________ which is being serviced by the
____________________ WATER DISTRICT under the aforementioned
account in my name;

3. That for the purpose TRANSFERRING/ASSIGNING the said account with the
__________________ WATER DISTRICT in the name of the new owners
__________________________, I am waiving all my rights and interests over
the same and have no objections whatsoever if even the same shall be
registered under their name;

4. That I am executing this Affidavit to attest to the truth of the foregoing and for
whatever legal intents and purposes it may duly serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of

___________ 2022 at ______________________, Philippines.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ___________

2023 at the City of ______________________, affiant exhibited to me her
__________________ with no. _________, as competent proof of her identity.

Doc. No.__________
Page No._________
Book No._________
Series of 2022