REPUBLIC OF THE PHILIPPINES)
La Trinidad, Benguet ) S.S.
x-------------------------------------x
                 AFFIDAVIT OF ADVERSE CLAIM
I, _______________, of legal age, Filipino, single and a resident of _______________,
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 the
      Register 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 claim
      over the parcel of land covered by the Transfer Certificate of Title No. 111222.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ___________ in
La Trinidad, Benguet, Philippines.
                            _____________________________
                                        Affiant