REPUBLIC OF THE PHILIPPINES)

CITY OF KIDAPAWAN ) S.S.

AFFIDAVIT OF PRE-EMPTION/
RETENTION/LANDHOLDINGS/NON-TENANCY

I, , of legal age, Filipino, single, and a resident of Kidapawan City, Cotabato, after having
been duly sworn to in accordance with law, hereby depose and say:

That I am the registered owner of a certain parcel of land identified as follows:

“Transfer Certificate of Title No. 152-2017001579 Lot No. 52-B PSD-

12-042359 being a portion of Lot 52, Block 4, PLS-59, containing an
area of THIRTY SEVEN THOUSAND FIVE HUNDRED (37,503)
SQUARE METERS, more or less, situated in Barangay of Manubuan,
Municipality of Matalam, Province of Cotabato, Island of Mindanao”

That I do not own either singly or jointly parcel of land anywhere in the Philippines in
excess of what the law provides;

That the said parcel of land is within my area of retention in accordance with the
Agrarian Reform of Laws of the Philippines;

That in accordance with the Agrarian Reform Laws of the Philippines, the said parcels of
land is not tenanted or the subject of any crop-sharing agreement;

IN WITNESS WHEREOF, I have hereunto set my hand this _________________at

Kidapawan City.

(AFFIANT)
TIN: _____________

SUBSCRIBED AND SWORN to before me this ________________________ at

Kidapawan City, Philippines. The affiant presented to me his identification card above-
mentioned bearing his photograph and signature as competent proof of his identity.

Doc. No.______;
Page No. _____;
Book No. _____;
Series of 2023/