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CARPER LAD Form No. 37
(Revised CARP-LAD Form No. 42)

Republic of the Philippines

DEPARTMENT OF AGRARIAN REFORM
Region No. IX
Province of Zamboanga del Norte
Municipality of SINDANGAN

APPLICATION TO PURCHASE AND FARMER’S UNDERTAKING

___________________________
Date

The Honorable Secretary

Department of Agrarian Reform
Diliman, Quezon City

Thru: The Municipal Agrarian Reform Program Officer

MILA D. BANQUIRIGO
Sir :

Pursuant to the provisions of the Republic Act (R.A.) No. 6657, as amended, and the pertinent
implementing rules and regulations, I/we, the identified and qualified agrarian reform
beneficiary/ies (ARBs) of the Comprehensive Agrarian Reform Program (CARP), do hereby apply to
purchase a parcel of the land owned by SIARE VALLEY AGRARIAN REFORM MULTI-PURPOSE
COOPERATIVE AS REP. BY FELIX C. POLISTICO, embraced by TCT No. T-1450 with Lot No.8 and
Approved Survey No. SC-21820 -CA, with a total area of 1.9288 more or less, and located at
(Municipality, Barangay) SINDANGANG, SIARE.

I/We obligate myself/ourselves to pay the land taxes thereon, and the amortization of the said
property computed in accordance with the prevailing and pertinent provisions of the
Comprehensive Agrarian Reform Law (CARL), its rules and regulations. Likewise, I/we acknowledge
and confirm that a lien by way of mortgage in favor of the Land Ban k of the Philippines (LBP) shall
secure our obligation after LBP undertakes to finance the acquisition of the subject
farmlots/homelots/other improvements, including interest thereon and penalties, if any.

I/We request that the said property be awarded to me/us under (/)individual ownership or ( )
collective ownership through our cooperative/farmer’s association ______________________.
(Indicate Name)

As recipient/s of Certificate of Land Ownership Award (CLOA), I/we shall make the land awarded to
me/us as productive as possible and I/we am/are aware that any negligence and misuse of the land
or any support services extended to me/us shall forfeit my/our rights to continue as beneficiary/ies
of the CARP.

Finally, I/we obligate myself/ourselves to comply with all the agrarian laws, rules and regulations
pertaining to the acquisition and distribution of the land applied for.

In consideration of the foregoing, I/we hereby affix my/our signature/s and/or right thumb mark/s
to this instrument correspondingly indicating the classification of the property purchased.
CARPER LAD Form No. 37/Page 1 of 2
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Classification ARBs Signature/or

Name of Qualified ARB Name of Spouse Address of the Thumb Mark
Property
Purchased

individual

individual
individual

“NOTHING FOLLOWS”

(Note: Use additional sheets, if necessary)

REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY/CITY OF _____________)S.S
PROVINCE OF _____________________)

Subscribed and sworn to before me this _________ day of _______________, 20____, in

_______________________________, personally appeared the following person/s, known to me
and to me known to be the same person/s who executed this sworn Application to Purchase and
Farmer’s Undertaking (APFU) after exhibiting to me the hereunder their valid identification
number:

Name of ARB
(Last Name, First Name, Valid Identification No. Date Issued
Middle Initial)

“ NOTHING FOLLOWS”
Note: Put a big X in the row immediately after writing/typing/encoding the name of the last ARB in the
list. Then put the words “NOTHING FOLLOWS”.(Use additional sheet, if necessary)

The above-named ARB/s acknowledged to me under oath that the same is his/her/their free and
voluntary deed and full comprehension of its legal consequences.

WITNESS MY HAND AND OFFICIAL SEAL

HON. ABRAHAM S. MARCABAN

Presiding Judge Branch No. 11,
Municipality of Sindangan Judicial Region
Copy Distribution:

Original : CF
Duplicate : DARMO File
Triplicate : ARB
Quadruplicate : DFFIC

CARPER LAD Form No. 37/Page 2 of 2

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CARPER LAD Form No. 37/Page 3 of 2