LTC Application No.

__________

Republic of the Philippines

City/Municipality of Sc.
Province of

APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCE

I/WE, ____________________ and ____________________, both of legal age,

Filipino citizens, married/single and residents of ______________________________, after
being sworn in accordance with law, hereby depose and state:

1. I/We am/are the parties in a ____________________ involving a parcel of land

covered by OCT/TCT No. _______________, with Lot No.
__________,Survey No. _______________, with an area of __________
hectares, more or less, and located at ______________________________
or declared under Tax Declaration No. _______________ ;

For purposes of this Application, I/we am/are applying for an area of __________
sq.m.

2. This Application for the issuance of Land Transfer Clearance (LTC) is not contrary to
law because both of us are qualified to dispose and acquire the land described above.
In addition, the said land is neither covered under the agrarian reform program nor
within the CARPER LAD Balance, and that the deed/contract will not violate the
retention limit provided under the law;

3. In support thereto and in compliance with DAR A.O. No. 4, Series of 2021, the
mandatory documents are hereto attached and made integral parts hereof as (please
check appropriate box):

3.1. FOR THE TRANSFEROR:

☐ Official Receipt of the Application (original) : Annex __

☐ Electronic Copy of the Titleissued not more than 6 months : Annex __
prior to filing
☐ Tax Declaration, if untitled, issued not more than 6 months : Annex __
(original/certified true copy)
☐ Deed or document to be registered (original/certified true : Annex __
copy)
☐ Affidavit of Aggregate Landholding (original/certified true : Annex __
copy)
☐ Retention
☐ Non-tenancy/tenancy with compliance of tenant’s
right of pre-emption and/or redemption
☐ No pending case before the regular courts or any
other tribunal involving the land subject of the
transaction
☐ If there is a case before the regular courts or any other
tribunal, the same had been decided with finality
☐ Municipal Assessor’s Certificate of Aggregate : Annex __
Landholding,issued not more than 6 months
(original/certified true copy)
☐ City Assessor’s Certificate of Aggregate Landholding, issued : Annex __
not more than 6 months (original/certified true copy)
☐ Provincial Assessor’s Certificate of Aggregate Landholding, : Annex __
issued not more than 6 months (original/certified true copy)
 LTC Form No. 1

3.2. FOR THE TRANSFEREE:

☐ Affidavit of Aggregate Landholding, issued not more : Annex __

than 6 months (original/certified true copy)
☐ Municipal Assessor’s Certificate of Aggregate : Annex __
Landholding, issued not more than 6 months
(original/certified true copy)
☐ City Assessor’s Certificate of Aggregate Landholding, : Annex __
issued not more than 6 months (original/certified true
copy)
☐ Provincial Assessor’s Certificate of Aggregate : Annex __
Landholding, issued not more than 6 months
(original/certified true copy)
☐ Municipal Agrarian Reform Program Officer : Annex __
Certification (LTC Form No. 2) (original/certified true
copy)

In addition to the above-mentioned requirements for a Corporation/ Cooperative:

☐ Original/ Certified copy of Secretary’s Certificate/ : Annex __

Board Resolution for a Corporation/ Cooperative
☐ Special Power of Attorney, if the Application is for and : Annex __
behalf of the Transferor/Transferee.

4. Having submitted/attached hereof the mandatory documents as required under DAR A.O.
No.04, Series of 2021, I/we hereby file this instant application/request to facilitate the
issuance of the corresponding Certification on LTC.

IN WITNESS WHEREOF, I/we have hereunto set our hands this _____ day of __________
20__ at __________, Philippines.

____________________ ____________________
Transferor Transferee

ID No. ID No.
Date Issued: Date Issued:
Place Issued: Place Issued:

SUBSCRIBED And SWORN TO before me this _____ day of __________ 20__ at

__________, affiants upon exhibiting to me his/their duly issued government ID/s with details
stated above.

Notary Public

Doc. No. ;
Page No. ;
Book No. ;
Series of 20__.

Copy Distribution:
Original: DARPO/LTC Folder
Duplicate: Applicant

Paalala: Paki-xeroxpoitong Form at pakilagaysa Folder

lahatngmgadokumentoayonsapagkakasunud-sunod.

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LTC Form No. 1

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