_________________
Date
Housing and Land Use Regulatory Board
___________________________________
________________________________
Attention:
The Director Region ___________________ Sir/Madam: May I request for certification as to whether or not the property/ies located in ________________ ________________________________________ or covered by transfer Certificate of Title No./s ________________ is/are within or outside the Urban Land Reform Zone, specifically, any of the Areas for Priority Development (APD), as per Prool. No. 1967 as amended by Prool. No. 2284,Said request is necessary for my: [ ] 1. Proposed ___________________________________________________ project specifically whether it is residential, commercial, industrial, etc; [ ] 2. Proposed sale/mortgage; [ ] 3. Proposed registration of new right and/or interest; [ ] 4. Proposed registration of existing rights end/or interest; [ ] 5. Pending case in Court; [ ] 6. Other (please specify) -____________________________________________________ Attached herewith are the following documents necessary therewith; [ ] 1. Vicinity map drawn to any scale or sketch map and affidavit as to actual location site; [ ] 2. Site Development plan drawn to scale; [ ] 3. Proof of ownership or right over the property certified true copy; [ ] 4. Tax Declaration; [ ] 5. Verification Form; [ ] 6. Deed of Sale; [ ] 7. Affidavit of non-tenancy or waiver by tenant or rights of refusal, if tenanted; Finally, I do hereby certify that the documents submitted herewith (or any other document that will be required of me) are to the beet of my knowledge, true and correct the same having been prepared personally by me or under my supervision and instruction. ______________________________
Applicant’s Signature
HLURB Form No. 1120 Republic of the Philippines) S.S. ---------------------------------)
A F F I D A V I T
I, ________________________________________________________ of legal age, ____________________________________, and a resident of and with postal address at _____________________________________________________ after having been sworn to in accordance with law, hereby depose and say: That I am a tenant/owner/authorized representative to the owner of a house/apartment/ parcel of land located at _________________________________________________________. That I have filed with Housing and Land Use Regulatory Board (HLURB) a request for certification as to whether or not the abovementioned property is within or outside the Urban Land Reform Zone (ULRZ) specifically any of the Areas for Priority Development (APD). That I have sketched or caused to be sketched a location map of said property for purpose of verification With ULRZ of the HLURB. That the said sketch is a faithful representation of the present arid actual location of the property per original/transfer certificate of title/tax declaration; That this affidavit is executed to attest to the veracity of the abovementioned facts, thereby satisfying the requirement of HLURB on my request for APD certification. Further, I sayeth naught. _____________________________, 200____, ______________________, Philippines _________________________ Affiant Republic of the Philippines ) ----------------------------------) SUBSCRIBED AND SWORN to before me this day of _____________________ 200________, in the City/Province of __________________________, affiant exhibited to me his/her Residence Certificate No. ___________________ issued at ________________________ on ____________________ 200________. Doc. No. ________; Page No. ________; NOTARY PUBLIC Book No. ________; Series 200________;
Republic of the Philippines Office of the President
Housing and Urban Development Coordinating Council HOUSING AND LAND USE REGULATORY BOARD
Region: __________________ Address: ____________________________________________ Form No. 1302-A
VERIFICATION FORM
FOR PROCLAMATION NO. 1957, PROCLAIMING 244 AREAS FOR PRIORITY DEVELOPMENT AND PROCLAMATION NO. 2284, PROCLAIMING DAGAT-DAGATAN AS AN AREA FOR PRIORITY DEVELOPMENT
NAME OF APPLICANT: [ ] Owner [ ] Tenant [ ] Others ____________ ADDRESS OF APPLICANT: Tel. No. NAME OF OWNER Tel. No. ADDRESS OF OWNER: Tel. No. NATURE OF TRANSACTION: [ ] Certification [ ] Existing Rights [ ] New Rights [ ] Sale [ ] Mortgage [ ] Lease Agreement SIGNATURE OF APPLICANT: LAND DESCRIPTION: Land Survey No. _________________________ Lot No. ____________ Block No. ____________ Portion of _______________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ Land Area_______________________________ Title No. ________________________________ Tax Declaration No. _______________________ Tax Declaration Description: ________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ LOCATION OF LAND: No. or Street ____________________________ Barangay _______________________________ Town/City ______________________________ Province _______________________________ (DO NOT FILL BELOW) RECORD FINDINGS VERIFICATION FINDINGS [ ] No Previous Record [ ] Has Previous Record [ ] Inside [ ] Outside [ ] Others ___________ NATURE OF PREVIOUS TRANSACTION NAME OF PREVIOUS APPLICANT ADDRESS OF PREVIOUS APPLICANT [ ] Inside APD Code [ ] Outside APD [ ] Others (see remarks) No. and Location of APD _____________________ __________________________________________ Remarks: _________________________________ __________________________________________ __________________________________________ __________________________________________ Verified by: Date Verified by: Date Noted by:
__________________________________
Head, RIU
FOR INTERNAL USE ONLY, NOT VALID FOR OUTSIDE TRANSACTION
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