Republic of the Philippines

DEPARTMENT OF AGRARIAN REFORM

Region X
Province of Lanao del Norte
City of Iligan

REQUEST FOR CERTIFICATION OF RETENTION

The Provincial Agrarian Reform Program Officer II

Engr. Alibasa G. Andig

Sir/Madam:

May I request for the Issuance of a Certification of Retention for my

landholding Pursuant to Republic Act (R.A) 665, as amended by R.A. 9700,
with a total area of 2.4796 hectares covered by the following:

OCT/TCT No. : T-16030 (a.f.)

TD No.: 18-0019-03612
Lot No. : 3047 & 3060 PRT Lot 9
Approved Survey Plan No.:
Location : Luinab, Iligan City

I certify under oath my total/aggregate ownership of agricultural land

nationwide is ___________ has and I have not sold or disposed of any
agricultural Landholding after June 15, 1988. This disclosure shall bind me to
place under CARP my excess agricultural lands

Very truly yours,

TERESITA L. BITOON
(Signature over printed name)

SUBSCRIBED and SWORN to before me this _____ day of

November, 2019 at Iligan City, affiant exhibited to me her SSS No. 08-
2159098-0.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2019