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I, _____________, of legal age, (single / married / widow), and a resident of _____________,

Philippines, after being sworn to in accordance with law, depose and state:

1.That I and the members of my family are presently occupying a property comprising a house
and lot belonging to _____________ and located at _____________;

2.That I expressly undertake to completely and fully vacate and peaceably surrender or redeliver
the physical possession of the said property, including the keys appertaining thereto, to
_____________ on or before _____________, without any extension whatsoever;

3.That I further expressly undertake to redeliver the physical possession of the said property to
_____________, as aforesaid, in good, clean, and sanitary condition, devoid of all occupants,
boarders, furnitures, articles, merchandise, etc., except those belonging to the _____________;

4.That should I fail to comply with the above-mentioned undertakings, then _____________, her
duly authorized representatives or any person acting in her behalf, shall have the right to
immediately enter and take possession of the subject property, with full power and authority to
open, enter, repossess, secure, enclose, padlock the means of entrance and exit, and otherwise
take full and complete physical possession and control of the premises, without need of any
further notice or demand or proceeding in court, holding in trust and custody all our belongings
found therein after an inventory of the same is made in the presence of a witness, all these acts
being hereby agreed to by me as tantamount to my voluntary vacation of the subject house and
lot without necessity of any further action in court;

5.That the above undertakings shall also be valid and binding on all the members of my family,
heirs, agents, representatives, successors, and assigns.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____________ at

_____________ Philippines.

OCCUPANT

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Republic of the Philippines)

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

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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)