Republic of the Philippines

REGIONAL TRIAL COURT

8th Judicial Region
Branch 10
Abuyog, Leyte

Republic of the Philippines)

____________, ________ ) s.s.

AFFIDAVIT OF ADVERSE CLAIM

I, ______________________, of Legal Age, Filipino, Married and with residential address

at Tacloban, City after having been duly sworn to in accordance with law, hereby depose and
state:

1. That on July 26, 2017, I have entered into a Deed of Conditional Sale which was
acknowledge on the same date before Notary Public Juan Sipag of Tacloban City and
entered in his Notarial register as Doc. No. 2, Page 2, Book II, Series of 2017.

A Copy of the said Deed is hereto attached as ANNEX A and made an integral part
of this affidavit;

2. That the said Deed of Conditional Sale, I was the VENDEE of a certain parcel of land
covered by Transfer Certificate Title No. 111222, more particularly described as
follows:
(Technical Description of Property)

3. That because I still have a balance on the purchase price in the amount of P500,000.00
which is payable within (1) year from the date of signing thereof, it was stipulated in
the aforementioned Deed that the title and ownership over the subject property will
only be transferred upon full payment of the same;

4. That the VENDOR in the said Deed of Conditional Sale agreed that upon its execution,
said Deed shall be annotated in the Title with the Office of the Register of Deeds of
Tacloban City;

5. However, since the said Deed of Conditional Sale per se could not be annotated on
the Title with the Office of the of the Register of Deeds, I am therefore executing this
Affidavit for the purpose of attesting to the truthfulness of the foregoing allegations
and in support of my request for the annotation of the adverse claim over the parcel
of land covered by the Transfer Certificate of Title No. 111222.

IN WITNESS WHEREOF, I have hereunto set my hand this _____day of

____________ 20__ in ______________ City, Philippines.

________________________
Affiant