Republic of the Philippines

Province of Davao del Norte

City of Tagum

AFFIDAVIT OF CONCENT

I ______________________________ of legal age, filipino______________________ with

residence and postal address at _______________________, Philippines, after having been duly sworn
to in accordance with the law do hereby depose and say:

That, I am the register owner of that parcel of land situated along __________________________
lot no. ______________ which covered under ORIGINAL/TRANSFER CERTIFICATE OF TITLE
NO.____________________ issued by the Office of the Registry of Deeds of Province of Davao del
Norte;

That being the owner of the said lot, I hereby give my full consent and authority to
______________________, to construct residential/building/install electricity;

That I am executing the affidavit for the purpose of affirming the truthfulness of the foregoing and
whatever legal purpose this may serve;

Further Affiance Sayeth None.

IN WITNESS WHEREOF, I have hereunto set my hands this ____day of _________, ______ at
Tagum City, Davao del Norte, Philippines.

___________________
Affiant

SUBSCRIBED AND SWORN BEFORE ME, this ____, day of ___________ at Tagum City, Davao
del Norte Philippines, with residence certificate no. _________________, issued on ______________ at
______________________.

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