REPUBLIC OF THE PHILIPPINES}

PROVINCE OF DAVAO DEL NORTE }S.S.

TAGUM CITY }
x----------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, ______________, of legal age, Filipino, married to ____________________ and

a resident of San Miguel, Samal District, Island Garden City of Samal, after having
been duly sworn to in accordance with law, depose and state:

1. That on December 7, 2012, I have entered into a Deed of Absolute Sale

which was acknowledged on the same date before Notary Public
_________of Davao City and entered in his Notarial Register as Doc. No.
______, Page ____, Book ___, Series of ______. A copy of the said Deed is
hereto attached as ANNEX “A” and made an integral part of this Affidavit;

2. That in the said Deed of Absolute Sale, I was the VENDEE of a certain
PORTION of a parcel of land, specifically Five Hundred (500) Square Meters,
more or less, thereof covered by Transfer Certificate of Title No. T-________,
more particularly described as follows:

A parcel of land (Lot 11, ______), being a portion of Plan ________),

situated in the Barangay of San Miguel, Municipality of Peňaplata

3. That because I still have a balance on the purchase price in the amount
of P500,000.00 which is payable within one (1) (year) from the date of
signing thereof, it was stipulated in the aforementioned Deed that 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 Makati City;

5. However, since the said Deed of Conditional Sale per se could not be
annotated on the Title with the Office 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 an adverse claim over the parcel of land covered by the
Transfer Certificate of Title No. ___________.
 IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of September
2013 in Makati City, Metro Manila, Philippines.

MARIE B. DELA CRUZ

Affiant

SUBCRIBED AND SWORN TO before me this 26th day of September 2013 in

Makati City, Metro Manila, Philippines, affiant exhibiting to me her Philippine
Passport No. 123456 issued in Manila on January 12, 2012 and valid until January
12, 2017.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013.