(Adverse Claim for Transferred Rights over Real Property)

Republic of the Philippines)

Province of ________________)S.S.
City/Municipality of _____________)
x-------------x

AFFIDAVIT OF ADVERSE CLAIM

I, _____________, of legal age, Filipino, (single / married / widow), and a
resident of _____________, after having been sworn to in accordance with law,
depose and say:

That I am one of the heirs of the late _____________.

That a certain _____________ previously entered into a Deed of Conditional

Sale with the (Government Service Insurance System (GSIS) or Pag-IBIG) for
the purchase of a parcel of land (including the improvements thereon) located at
_____________, more particularly described as follows:

(Technical Description of Property) That on _____________, _____________

executed a (Deed of Transfer of Rights / Assumption of Obligations) in favor of
the late _____________, which document is more particularly identified as
Document No. ______, Page No. ______, Book No. ______, Series of ______ in
the Notarial Register of Notary Public _____________ and a copy of which is
attached herein.

That in said (Deed of Transfer of Rights / Assumption of Obligations),

_____________, for valuable consideration received, ceded, transferred and
conveyed to _____________, his heirs, successors and/or assigns, all his rights,
interest and participation in the purchase of the aforedescribed parcel of land.

That as such, _____________ has since then relinquished all his rights, interest
and participation over the aforedescribed parcel of land in favor of the late
_____________ and his heirs.

However, it has come to my knowledge that _____________ is presently

claiming to still have an interest over the aforementioned parcel of land and is
attempting to sell or dispose of the same despite the fact that he has already
conveyed all his rights and interests thereon to _____________ and his heirs.

That unless an adverse claim is annotated on the aforedescribed Transfer

Certificate of Title, the heirs of _____________ are in danger of being defrauded
and deprived of their just and valid right over the aforedescribed parcel of land
and, as such, I am executing this Affidavit in support of my request for the
annotation of an adverse claim over the parcel of land described herein.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________, in

the City / Municipality of _____________, Philippines.

Affiant

(JURAT)