Republic of the Philippines

)
City/Municipality of ___________________) S.S.
Province of Camarines Norte
)

AFFIDAVIT
I,
MR.
ANGEL
MARTINEZ
of
legal
age,
residing
at
______________________________________________________, after having been duly
sworn to in accordance with Law, do hereby depose and state the following:
That, I am executing this affidavit to give permit to the Department of Public Works and
HighwaysCamarines Norte District Engineering Office, Daet, Camarines Norte to
ENTER AND CONSTRUCT ROADS in the affected lot under TCT NO. ______________Tax
Declaration
No.________________
in
connection
with
the
CONSTRUCTION/IMPROVEMENT OF ACCESS ROADS LEADING TO AIRPORT,
SEAPORTS & DECLARED TOURISM DESTINATIONS. a. To declared Tourism
Destinations; Daet-Talobatib-Batobalani-Paracale Toad leading to Calaguas Island
(Mahabang Buhangin), Pulang Daga Beach & SEnakulo to GUmaus and Bulalakao Beach
Camarines Norte a. Pulang Daga- GUmaus Bridge at Brgy. Gumaus, Paracale, Camarines
Norte to be undertaken by the Department of Public Works and HighwaysCamarines Norte
District Engineering Office, Daet, Camarines Norte.
That, I am the owner/claimant/occupant over the affected lot.
That, I am executing this affidavit to attest to the truthfulness of the foregoing and for whatever
legal purposes this statement may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ________________________,
in _____________________________________, Philippines.
MR. ANGEL MARTINEZ
(Affiant)
SUBSCRIBED AND SWORN to before me this ___________________________, affiant
Exhibited to me his / her ______________________no._______________________ issued on
_____________________at_________________________, Philippines.

Doc No._______
Series of 2016.

Republic of the Philippines

)
City/Municipality of ___________________) S.S.
Province of Camarines Norte
)

AFFIDAVIT
I, ______________________________of legal age, residing at
_________________________________ after having been duly sworn to in accordance with
Law, do hereby depose and state the following:
That, I am executing this affidavit to give permit to the Department of Public Works and
HighwaysCamarines Norte District Engineering Office, Daet, Camarines Norte to
ENTER AND CONSTRUCT A FARM TO MARKET ROAD under local Infrastructure
Program in the affected lot under TCT NO. _______________Tax Declaration No.
___________________
in
connection
with
the
_____________________________________________________ to be undertaken by the
Department of Public Works and HighwaysCamarines Norte District Engineering Office,
Daet, Camarines Norte.
That, I am the owner/claimant/occupant over the affected lot.
That, I am executing this affidavit to attest to the truthfulness of the foregoing and for
whatever legal purposes this statement may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ________________________,
in _____________________________________, Philippines.

_____________________________
(Affiant)
SUBSCRIBED AND SWORN to before me this ___________________________, affiant
exhibited to me his / her ______________________no._______________________ issued on
_____________________at_________________________, Philippines.

Doc No._______
Series of 2016

Republic of the Philippines

)
City/Municipality of ___________________) S.S.
Province of Camarines Norte
)

AFFIDAVIT
I, ______________________________of legal age, residing at
_________________________________ after having been duly sworn to in accordance with
Law, do hereby depose and state the following:
That, I am executing this affidavit to give permit to the Department of Public Works and
HighwaysCamarines Norte District Engineering Office, Daet, Camarines Norte to
ENTER AND CONSTRUCT A DETOUR ROAD under local Infrastructure Program in the
affected lot under TCT NO. _______________Tax Declaration No. ___________________ in
connection with the _____________________________________________________ to be
undertaken by the Department of Public Works and HighwaysCamarines Norte District
Engineering Office, Daet, Camarines Norte.
That, I am the owner/claimant/occupant over the affected lot.
That, I am executing this affidavit to attest to the truthfulness of the foregoing and for
whatever legal purposes this statement may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ________________________,
in _____________________________________, Philippines.

_____________________________
(Affiant)
SUBSCRIBED AND SWORN to before me this ___________________________, affiant
Exhibited to me his / her ______________________no._______________________ issued on
_____________________at_________________________, Philippines.

Doc No._______
Series of 2015.

Republika ng Pilipinas
)
Bayan ng ________________) S.S.
Lalawigan ng_____________)

KASUNDUAN
SA MGA KINAUUKULAN:
Ang kasunduang ito ay para sa pagsasagawa ng detour sa lupang pag-aari ng
pribadong tao para sa pagsasaayos ng tulay ng Itomang, bilang isa sa pangunahing
proyekto ng Tangapan ng Department of Public Works and Highways, ay ginawa at
nilagdaan noong ika______ ng buwan ng __________ sa Bayan ng Daet, Lalawigan ng
Camarines Norte, ng magkabilang panig na sina:
ENGR. ELMER R. REDRICO, OIC-District Engineer, kumakatawan sa Department
of Public Works and Highways-Camarines Norte District Engineering Office
na may tangapan sa F. Pimentel Avenue, Daet, Camarines Norte.
At
G._________________, naninirahan sa Brgy. Binanuaan, Talisay, Camarines Norte at
nagmamay-ari ng lupang daraanan ng isasagawang detour para sa pagsasaayos ng
tulay ng Itomang.
Na kung saan, si G._______________________, ay nagbigay ng kaukulang permiso sa
tangapan ng DPWH upang makaraan sa lupang kanyang pag-aari at maisagawa ang
nasabing proyekto;
Na kung saan, si G._________________________, ay humiling sa tangapan ng DPWH
na ang ginamit na panambak sa isasagawang detour ay maipagkakaloob sa kanila
pagkatapos ng proyekto.
Na kung saan, si Engr. Elmer R. Redrico, bilang kinatawan ng DPWH ay pumayag
sa kahilingan ni G.________________.
Dahil dito, napagkasunduan ng dalawang panig na gumawa ng kasulatan at
lagdaan ang kasunduang ito.

_________________________
ENGR. ELMER R. REDRICO
OIC-District Engineer
DPWH-CNDEO

___________________________
G.____________________
Brgy. Binanuan, Talisay
Camarines Norte

Republika ng Pilipinas
)
Bayan ng ________________) S.S.
Lalawigan ng_____________)

KASUNDUAN

SA MGA KINAUUKULAN:
Ang kasunduang ito ay para sa pagsasagawa ng detour sa lupang pag-aari ng
pribadong tao para sa pagsasaayos ng tulay ng Tawig, bilang isa sa pangunahing
proyekto ng Tangapan ng Department of Public Works and Highways, ay ginawa at
nilagdaan noong ika______ ng buwan ng __________ sa Bayan ng Daet, Lalawigan ng
Camarines Norte, ng magkabilang panig na sina:
MS. MA. JHOANNA C. ONG, kumakatawan sa JCO CONSTRUCTION AND SUPPLY
na may tangapan sa P.Cababan St.,San Vicente, Camarines Norte.
At
G._________________, naninirahan sa ____________________________at nagmamay-ari ng
lupang daraanan ng isasagawang detour para sa pagsasaayos ng tulay ng Tawig.
Na kung saan, si G._______________________, ay nagbigay ng kaukulang permiso sa
tangapan ng JCO Construction and Supply upang makaraan sa lupang kanyang pagaari at maisagawa ang nasabing proyekto;
Na kung saan, si G._________________________, ay humiling sa tangapan ng DPWH
na pagkatapos ng proyektong ito, ang isinagawang detour ay kanilang tatangalin at
ibabalik sa dating kaayusan ang kanilang lupaing sinasaka.
Na kung saan, si Engr. Elmer R. Redrico, bilang kinatawan ng DPWH ay pumayag
sa kahilingan ni G.________________ at pinag utusan ang kinatawan ng JCO
Construction and Supply upang maisakatuparan ang kahilingan ng may ari ng
lupang daraanan ng detour road.
Dahil dito, napagkasunduan ng dalawang panig na gumawa ng kasulatan at
lagdaan ang kasunduang ito.

__________________________
MS. MA. JHOANNA C. ONG
JCO Construction & Supply
P. Cababan St. San Vicente
Camarines Norte

___________________________
G.____________________
Brgy. Tawig, Paracale
Camarines Norte

MGA SAKSI:

____________________
__
ENGR. ELMER R. REDRICO
OIC-District Engineer
___________________________
DPWH- CNDEO

______________________
______________________

Republic of the Philippines

)
City/Municipality of ___________________) S.S.
Province of Camarines Norte

AFFIDAVIT

I,
____________________________of
legal
age,
residing
at
_____________________________, after having been duly sworn to in accordance with Law, do
hereby depose and state the following:
That, I am executing this affidavit to authorized the Department of Public Works and
HighwaysCamarines Norte District Engineering Office, Daet, Camarines Norte to
ENTER AND CONSTRUCT A LOCAL ROAD in the affected lot under TCT NO.
______________Tax Declaration No.________________ in connection with the
CONSTRUCTION OF FARM TO MARKET ROAD at Brgy. Gahonon, Daet, Camarines
Norte to be undertaken by the Department of Public Works and HighwaysCamarines Norte
District Engineering Office, Daet, Camarines Norte.
That, I am the owner/claimant/occupant over the affected lot.
That, I am executing this affidavit to attest to the truthfulness of the foregoing and for whatever
legal purposes this statement may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ________________________,
in _____________________________________, Philippines.
______________________________
(Affiant)
SUBSCRIBED AND SWORN to before me this ___________________________, affiant
Exhibited to me his / her ______________________no._______________________ issued on
_____________________at_________________________, Philippines.
Doc No._______
Series of 2016.

Republic of the Philippines

)
City/Municipality of ___________________) S.S.
Province of Camarines Norte
)

AFFIDAVIT

I,
____________________________
of
legal
age,
residing
at
____________________________________ after having been duly sworn to in accordance with
Law, do hereby depose and state the following:
That, I am executing this affidavit to authorized the Department of Public Works and
HighwaysCamarines Norte District Engineering Office, Daet, Camarines Norte to
ENTER, CONDUCT SURVEY WORKS AND CONSTRUCT A RIVER CONTROL
STRUCTURE ALONG DAET RIVER in the affected lot under TCT NO.
______________Tax Declaration No.________________ in connection with the
CONSTRUCTION/MAINTENANCE OF FLOOD MITIGATION STRUCTURES &
DRAINAGE SYSTEMS; REHABILITATION/IMPROVEMENT OF DAET RIVER
CONTROL ALONG BRGY. III SECTION at the Municipality of Daet, this province to be
undertaken by the Department of Public Works and HighwaysCamarines Norte District
Engineering Office, Daet, Camarines Norte.
That, I am the owner/claimant/occupant over the affected lot.
That, I am executing this affidavit to attest to the truthfulness of the foregoing and for whatever
legal purposes this statement may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ________________________,
in _____________________________________, Philippines.

______________________________
(Affiant)
SUBSCRIBED AND SWORN to before me this ___________________________, affiant
exhibited to me his / her ______________________no._______________________ issued on
_____________________at_________________________, Philippines.

Doc No._______
Series of 2016