To:

The Chief, The Register of Deeds

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AFFIDAVIT of ADVERSE CLAIM

I, ___________________________, after first being sworn according to law, do

hereby state:

1. That I have an adverse claim in that certain registered real property, more
particularly described as follows:

covered by Original/ Transfer Certificate of Title No. _______________________

issued in the name of ____________________ as the registered owner;

2. That my adverse claim consists of right of ownership over one-half (1/2) share
in the property above described, the same having been acquired by me by
virtue of my being the compulsory heir of the late Santiago de Guzman
married to my biological mother Priscilla Rafa de Guzman;

3. That said registered owner has refused and still refuses to execute the
necessary deed of sale within the period agreed upon;

4. That I am a resident of ________________ to which all notices may be

reserved upon me.

WHEREFORE, I hereby request the Register of Deeds of

___________________ to register this adverse claim in the manner provided by law.

_____________________

(Adverse Claimant)

SUBSCRIBED AND SWORN TO before me this ________________ at

_____________________________, affiant exhibiting her CTC No. _____________
issued at Calapan City on _______________________.

NOTARY PUBLIC

Doc. No.______
Page No.______
Book No._____
Series of 2011.