Republika ng Pilipinas           )
Lungsod ng Lipa                  ) SS.
                            AFFIDAVIT OF OCCUPANCY
      Ako si, __________________________, Pilipino, nasa wastong taong gulang, at
kasalukuyang naninirahan sa Lipa City, Batangas, matapos manumpa ng ayon sa batas,
ay malaya at kusang loob na nagsasalaysay ng mga sumusunod:
      1.     Na ako ay kasalukuyang naninirahan sa Barangay __________________ ,
Lipa City, Batangas, na bahagi ng Philippine National Railways (PNR) ‘unutilized
properties/non-core properties for disposition’ o ‘properties outside PNR Right-of-Way
Retention Area and reserved as housing site for informal settlers’ sa nasabing barangay
na may Technical Description nakalakip dito bilang Annex “A”;
      2.    Na ang paninirahan ko o/at ng pamilya ko dito ay eksklusibo at walang
sinuman bukod pa sa amin ang nanirahan dito;
      3.     Na isinasaad ko ang lahat ng ito ayon sa Executive Order No. 48, series of
2001, Rules and Regulations Implementing Executive Order No. 48, series of 2001,
Declaring Non-Core Properties of the Philippine National Railways (PNR) as Socialized
Housing Sites and Providing for the Disposition of the Same to Bonafide Occupants;
Memorandum Order No. 147 from the Office of the President Directing the Housing and
Urban Development Coordinating Council (HUDCC) to Formulate a Master Development
Plan for the Acquisition, Development and Disposition of Philippine National Railways
(PNR) Property in Lipa City, Identified as Outside of Right-of-Way Retention Area and
Reserved as Housing Site for Informal Settlers Presently Residing Therein; Executive
Order No. 11-2015 from the Office of the City Mayor of Lipa City--Honorable MEYNARD
A. SABILI, An Order Creating Local Housing Board of the City of Lipa; at iba pang may
kaugnayang batas o tuntunin;
        4.    Na isinasalaysay ko ang lahat ng ito upang magpatotoo sa mga nakasaad
dito at para sa anumang legal na layunin.
     Bilang Saksi, akin pong lalagdaan ito sa ibaba ngayong ika _______ na araw ng
______, 2019 sa ________________________.
                                             ________________
                                                Nagsasalaysay
       SUBSCRIBED AND SWORN TO before me in the City of LIPA, Philippines, this
day of _________________, affiant exhibiting me his/her Government-issued ID as
competent evidence of identity.
                                                 Notary Public
Doc. No. ____;
Page No.____;
Book No. ___;
Series of 2019.