REPUBLIC OF THE PHILIPPINES

)
CITY OF MAKATI
) S.S.
x-------------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, MARIE B. DELA CRUZ, of legal age, Filipino, single and a

resident of 2223 Washington Street, Pio del Pilar, Makati City, after
having been duly sworn to in accordance with law, depose and state:
1. That on July 10, 2013, I have entered into a Deed of Conditional Sale
which was acknowledged on the same date before Notary Public Juan
Tamad of Makati City and entered in his Notarial Register as Doc. No. 2,
Page 2, Book II, Series of 2013. A copy of the said Deed is hereto
attached as ANNEX A and made an integral part of this Affidavit;
2. That in the said Deed of Conditional Sale, I was the VENDEE of a
certain parcel of land covered by Transfer Certificate of Title No.
111222, more particularly described as follows:
(Technical Description of Property)
3. That because I still have a balance on the purchase price in the
amount of P500,000.00 which is payable within one (1) (year) from the
date of signing thereof, it was stipulated in the aforementioned Deed
that title and ownership over the subject property will only be
transferred upon full payment of the same;
4. That the VENDOR in the said Deed of Conditional Sale agreed that upon
its execution, said Deed shall be annotated in the Title with
the Office of theRegister of Deeds of Makati City;
5. However, since the said Deed of Conditional Sale per se could not be
annotated on the Title with the Office of the Register of Deeds, I am
therefore executing this Affidavit for the purpose of attesting to the
truthfulness of the foregoing allegations and in support of my request
for the annotation of an adverse claimover the parcel of land covered
by the Transfer Certificate of Title No. 111222.
IN WITNESS WHEREOF, I have hereunto set my hand this 26th
day of September 2013 in Makati City, Metro Manila, Philippines.

MARIE B. DELA CRUZ

Affiant

SUBCRIBED AND SWORN TO before me this 26th day of

September 2013 in Makati City, Metro Manila, Philippines, affiant
exhibiting to me her Philippine Passport No. 123456 issued in Manila on
January 12, 2012 and valid until January 12, 2017.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.

Republic of the Philippines

)
Province of ________________ ) S. S.
City/Municipality of _________ )
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:
1. That I am one of the heirs of the late _____________.
2. 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)
3. 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.

4. 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.

5. 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.
6. 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.
7. 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
SUBCRIBED AND SWORN TO before me this 26th day of
September 2013 in Makati City, Metro Manila, Philippines, affiant
exhibiting to me her Philippine Passport No. 123456 issued in Manila on
January 12, 2012 and valid until January 12, 2017.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.