PRLD.0005.

02

REPUBLIC OF THE PH I LIPPINES

Department of Human Settlements and Urban Development

Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
NATIONAL CAPITAL REGION

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 EO No. 648.

4.) That in the event that a project does not exist, located in the same province as our
project and is registered with the DHSUD 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

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