Republic of the Philippines ) Province of________________ ) S.S.

City/Municipality of_________ ) x- - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF ADVERSE CLAIM FOR TRANSFERRED RIGHTS OVER REAL PROPERTY

I, ________________, of legal age, (single/widow/married to _____________________), Filipino citizen, and a resident of _______________, Philippines, after being sworn to in accordance with law, depose and state: That I am one of the heirs of the late _____________. That a certain _____________ previously entered into a Deed of Conditional Sale with the (Government Service Insurance System (GSIS) or (Pag-IBIG) for the purchase of a parcel of land (including the improvements thereon) located at ____________________, more particularly described as follows: (Technical Description of Property) That on _____________, _____________ executed a (Deed of Transfer of Rights/Assumption of Obligations) in favor of the late _____________, which document is more particularly identified as Document No. ______, Page No. ______, Book No. ______, Series of ______ in the Notarial Register of Notary Public _____________ and a copy of which is attached herein. That in said (Deed of Transfer of Rights/Assumption of Obligations), ________________, for valuable consideration received, ceded, transferred and conveyed to _____________, his heirs, successors and/or assigns, all his rights, interest and participation in the purchase of the aforedescribed parcel of land. That as such, _____________ has since then relinquished all his rights, interest and participation over the aforedescribed parcel of land in favor of the late _____________ and his heirs. However, it has come to my knowledge that _____________ is presently claiming to still have an interest over the aforementioned parcel of land and is attempting to sell or dispose of the same despite the fact that he has already conveyed all his rights and interests thereon to _____________ and his heirs. That unless an adverse claim is annotated on the aforedescribed Transfer Certificate of Title, the heirs of _____________ are in danger of being defrauded and deprived of their just and valid right over the aforedescribed parcel of land and, as such, I am executing this Affidavit in support of my request for the annotation of an adverse claim over the parcel of land described herein. FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of ___________, 20____ at Barangay ___________, __________, ____________, Philippines.

_____________________ Affiant

(NOTARIAL OATH)