REPUBLIC OF THE PHILIPPINES )

CITY OF ______________ )
x----------------------------------------------x

AFFIDAVIT NON-RENTAL

I, _____________________________________, of legal age, Filipino, married to

_____________________________________ and with address at
_____________________________________, Philippines, after being sworn to in accordance
with law, do hereby depose and state:

1. That I am the owner of two (2) parcels of land (hereinafter “Properties”), located at
_____________________________________, Philippines, particularly,
______________ and ______________, which are covered by Transfer Certificate of
Title Nos. ______________ and ______________, as well as indicated in the
Certification dated ______________ and ______________ issued by the Office of the
City Assessor – ______________, hereto attached and marked as Annexes “A”, “B”,
“C”, and “D” respectively;

2. That the said Properties are being occupied by ______________ (hereinafter

“______________”), a sole proprietorship, duly organized and existing by virtue of and
under the laws of the Philippines, with business address at ______________,
Philippines, duly represented by its Proprietor, ______________, as evidenced by the
Certificate of Business Name Registration from the Department of Trade and Industry
(“DTI”) with Certificate No. ______________, hereto attached and marked Annex
“E”.

3. That as the owner of the aforementioned Properties, I have authorized and empowered
and do hereby authorize and empower ______________ to occupy and use the said
Properties during its lifetime, with no rental fees being charged or collected or to be
charged or collected;

I am executing this Affidavit to attest to the truth of the foregoing and for whatever purpose
it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

_____________________________________
Affiant
With my conformity:

_____________________________________

SUBSCRIBED AND SWORN to before me this __________________, affiants, who

personally appeared, exhibited their (Government-issued IDs) __________________ and
__________________, which are competent evidence of identity under existing Notarial laws, rules
and regulation.

Doc No.____
Page No.___
Book No. I
Series of 2016.