REPUBLIC OF THE PHILIPPINES)

CITY OF _________ ) S.S.

x-------------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, _________________________, of legal age, Filipino,
__________, personally and in representation of heirs, and a resident of
_______________________________________ after having been duly
sworn to in accordance with law, depose and state:

1. That on ________________________, my parents

________________________________________ have entered a Land
Purchase Agreement which was acknowledged on ____________ before
Notary Public ___________________________ of Manila and entered in his
Notarial Register as ________________________________. A copy of the
said Agreement is hereto attached as ANNEX “A” and made
an integral part of this Affidavit;

2. The possession of the said land was transferred to the PURCHASER upon
execution of the LAND PURCHASE AGREEMENT.

3. ____________________________________________ died on
__________________________________ respectively and the undersigned
are the heirs.

4. That in the said LAND PURCHASE AGREEMENT, my parents was the

PURCHASER of a certain parcel of land covered by Transfer Certificate of
Title No. ______________________, more particularly described as follows:

LAND DESCRIPTION

5. The new owner is fully aware that the property is in our possession as an
owner of the said land.

6. The co-heir executed a special power of attorney in favor of the affiant.

 IN WITNESS WHEREOF, I have hereunto set my hand
this ____________ of _________________________,
__________________, Philippines.

_______________
Affiant

SUBCRIBED AND SWORN TO before me this

________________________ in ___________, Metro Manila, Philippines,
affiant exhibiting to me her Philippine Passport No. ________ issued in
Manila on __________ and valid until ____________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.