REPUBLIC OF THE PHILIPPINES)

CITY OF BACOLOD ) S.S.

x----------------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, ______________, of legal age, Filipino, and a resident of
_______________, Philippines, after having been duly sworn to in accordance
with law, depose and state:

1. I purchased a portion of the parcel of land covered by Transfer Certificate of

Title No. _________, known as Lot _________, with an area of
_________square meters out of the total area of _________hectares, more
or less, located _________ through a Deed of Conditional Sale dated
_________ with _________, of legal age, Filipino, married, and a resident
of _________. A copy of the said Deed of Conditional Sale is hereto attached
as Annex “A”.

2. I am therefore executing this Affidavit to protect my rights and interests over

the parcel of land covered by the Transfer Certificate of Title No.
_________and in support of my request for the annotation of an adverse
claim over the said parcel of land.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of March,
2024 in Bacolod City, Philippines.

________________________
Affiant/ Adverse Claimant

SUBSCRIBED AND SWORN to before me this _____ day of March, 2024 in

the City of Bacolod, Philippines, the Affiant exhibiting to me her Gov’t Issued I.D.
No. ___________________ issued at _________ on ___________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2024.