LTC Form No.

1
Republic of the Philippines ) LTC Application No. _____
City/Municipality of )S.S
Province of ________________)

APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCE

WE, ANTONIO C. SADIA married to ERLINDA C. SADIA, of legal age, Filipino citizen,
and resident of Toledo St., Bucal, Silang Cavite, after being sworn in accordance with law, hereby depose
and state:

1. We are the parties in DEED OF ABSOLUTE SALE OF A PORTION OF LAND involving a

parcel of land covered by Lot Not No.14021-A- part, with an area of 0.7490 square meter covered by
Tax Declaration Number 18-019-01360, of which PORTION of TWO THOUSAND FOUR
HUNDRED (2,400) square meter more or less has been sold to ANTONIO C. SADIA married to
ERLINDA C. SADIA , located at Bucal, Silang, Cavite.

2. This application for the issuance of Land Transfer Clearance (LTC) is not contrary to law because
both of us are qualified to dispose and acquire described above. In addition, the said land is neither
covered under the agrarian reform program not within the CARPER LAD balance and that the
deed/contract will not violate the retention limit provided under the law.

3. In support thereto and compliance with DAR A O No. 4 Series of 2021, the mandatory documents are
hereto attached and made integral part hereof as appropriate box.

3.1. FOR THE TRASFEROR:

 Official Receipt :Annex____

 Electronic Copy of the Title :Annex____
 Affidavit of Aggregate Landholding :Annex____
 Affidavit of Retention Non Tenancy/tenancy with :Annex____
Compliance of tenant’s right of Pre-emption and/
or Redemption and no pending case before the
land subject of the transaction, if there is a case
before the regular courts or any other tribunal the
same had been decided with finality or Affidavit of
transferee in the case of extrajudicial settlement
 City Assessor’s Certificate of Aggregate Landholding :Annex____
 Provincial or City Assessor’s Certificate if not a :Annex____
resident of Cavite Province

3.2 FOR THE TRANSFEREE:

 Affidavit of Aggregate Landholding :Annex____

 City Assessor’s Certificate of Aggregate Landholding :Annex____
 Provincial Assessor’s Certificate of Aggregate :Annex____
Landholding
 Municipal Agrarian Reform Program Officer :Annex____

Certification (LTC form No.2)

 Provincial or City Assessor’s Certificate if not a :Annex____
resident of Cavite Province
 Special Power of Attorney (if applicable) :Annex____
 Secretary’s Certificate (in case of a corporation) :Annex____
4. Having submitted/attached hereof the mandatory documents as required under DAR A.O No.4,
Series of 2021, I/we hereby file this instant application/request to facilitate the issuance of the
corresponding Certificate of LTC.

IN WITNESS WHEREOF, we have hereunto set our hands this ____ day of ___ 2023___ at
______________, Philippines.

ANTONIO C. SADIA ERLINDA C. SADIA

Applicant Applicant

SUBSCRIBED AND SWORN to before me this _____ day of ___2023 at

____________________ affiants upon exhibiting to me their duly issued government IDs with details
stated above.

NOTARY PUBLIC

Doc No. ____;

Book No.____;
Page No. ____;
Series of 2023.