Republic of the Philippines )

City of _______ ) S.S

Province of _______ )

AFFIDAVIT OF TRANSFEROR

I, ___________________, Filipino, of legal age, single and a resident of

__________________________ after having sworn to law, hereby depose and say:

1. That I am the vendor of a parcel of land known as ___________, situated in

_________________________________, with an area of ____ square meters
which I sold to _________________________ in a Deed of Absolute Sale dated
_____________ embodied in a Doc. No. ____, Page No. ____, Book No.
______, Series of 20__.

2. That the land subject of the above mentioned transaction is a portion of my

retention area.

3. That this affidavit is executed in compliance with DAR Administrative Order No.
1, Series of 1989, as well as to show proof that the land subject of the above
mentioned transaction is a portion of my retention area.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ___________20___ at

____________________affiant exhibited his/her ID/Community Tax Certificate
No.____issued at _________________on ________________,20____.

NOTARY PUBLIC
Doc. No. ________
Page No. ________
Book No. ________
Series of 20______