PRLD.0005.

02
Housing and Land Use Regulatory Board
Expanded National Capital Region Field Office
6th Floor, Sunnymede IT Center,
1614 Quezon Avenue, South Triangle, Quezon City

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 (position)of (name of corporation) ,

owner/developer of (name of project) 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 HLURB 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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