(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)