REPUBLIC OF THE PHILIPPINES }

PROVINCE OF RIZAL }
MUNICIPALITY OF _____________ }S.S.

AFFIDAVIT OF APPLICANT FOR RESIDENTIAL FREE PATENT

I, _________________________________________________________ of legal age,

(Single/Married/Widow/Widower) Filipino, Citizen, and resident of
__________________________________________________ in accordance to law, herby and
voluntary depose and state;

That I am the holder of Residential Free Patent Application No.

_________________, for parcel of land described as Lot No. __________________
Cad No. _________________, situated at Barangay ________________
Municipality of ____________Province of Rizal, containing an area of
___________ square meters;

That I am the owner, actual possession and occupation of the

abovementioned parcel of land that I acquired my ownership thru
_____________________ since _________up to this present;

That the above-mentioned parcel of land is the only land that I

applied for Residential Free patent under Republic Act No. 10023 in the
Municipality of ______________________ Province of Rizal;

That I am hold myself solely responsible for any liability, whether civil
and criminal that arises if the corresponding Certificate of Title had it in fact
been issued and for any statement;

That I executed this affidavit in support to my residential free patent

application freely, voluntarily and fully understand the contents hereof.

IN WITNESS WHEREOF, I have hereunto signed my name this _____ day of

_________________, 2022 at _________________________.

_______________________________
Applicant’s Name and Signature

SUBSCRIBED AND SWORN TO BEFORE ME this _____ day of

______________, 2022, at ________________________________________ affiant exhibited
to me his/her CTC/ID No. _______________ issued on _______________ at
_____________________.

_________________________
Officer Authorized to
Administer Oath