Republic of the Philippines )

PROVINCE OF Northern Samar ) S.S

MUNICIPALITY OF ___________ )

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSON

We, _____________________ and ___________________, both of

legal age, Filipinos, and a resident of Brgy. _____________, ___________,
Northern Samar, after having been duly sworn to in accordance with law, hereby depose
and state:

That we personally know ________________, of legal age, Filipino, and a

resident of Brgy. ________________, Northern Samar;

That to the best of our knowledge and belief, we know for a fact that said
______________ has been the actual tiller and cultivator of a parcel of land
situated in Brgy. ________________, Northern Samar, designated as Lot No.
_______, and covered by ___________;

That we further know that said landholding was covered by the Comprehensive
Agrarian Reform Program;

That we hereby declare and attest that said _______________ is the

qualified farmer-beneficiary of the portion of the above-described landholding being the
actual tiller over the same, and he possesses the basic qualifications as farmer
beneficiary and has the willingness, ability and aptitude to cultivate and make the land
as productive as possible;

That we are not related to the interested party neither by consanguinity nor
indirectly;

That we are executing this sworn statement to attest to the foregoing facts to
support the Petition for Inclusion of the said landholding in favor of said
______________ to be the farmer beneficiary of the same;

That we executed this affidavit for whatever legal purpose it may serve best.

IN WITNESS WHEREOF, we have hereunto affixed my signature this____

day of ___________, 2021 at Catarman, Northern Samar.

_________________
Affiant
CEI: _______________
Issued On____________
Issued At ____________
_________________
Affiant
CEI:________________
Issued On. ___________
Issued At ____________

SUBSCRIBED AND SWORN to before me this ____ day of

_________, 2021 at Catarman, Northern Samar by affiants exhibiting their CTC
Numbers duly noted below their signatures above.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2021.