FORM No. 1: SIGNATURE OF A. DELA CRUZ and PONCIANO L.
COUNSEL MARIANO, whose positive identifications
are duly noted above below their respective
ATTY. ANDREW B. CAYABYAB names and signatures, known to me and to me
Roll No. 20706 known to be the same persons who executed
Capas, Tarlac 2315, Philippines and voluntarily signed the foregoing
PTR No. 4330869, 01-03-17, Capas, Tarlac instrument and acknowledged before me that
IBP O. R. No. 1022022, 01-03-17, Tarlac Chapter the same is their free act and deed.
MCLE Compliance Certificate No.
V-0021747 until 04-14-2019 This instrument pertains to an DEED
Contact No. 0917-123-4567 OF ABSOLUTE SALE over a parcel of land,
which instrument consists of three (3) pages
-oOo- including this page on which this
acknowledgment is written, and signed at the
FORM No. 1.1: SIGNATURE OF left margin of each and every page thereof by
COUNSEL BY A LAW FIRM the parties executing this instrument and their
witnesses.
DIZON, KADATAR & CAYABYAB
LAW OFFICE WITNESS MY HAND AND SEAL.
Counsel for the Plaintiff
Km. 101 McArthur Highway, Brgy. Anupul (Signature of Notary Public)
Bamban,Tarlac 2317, Philippines
Doc. No. _____;
By: Page No. _____;
Book No. ____;
ATTY. ANDREW B. CAYABYAB Series of 20___.
Roll No. 20706
Capas, Tarlac 2315, Philippines -oOo-
PTR No. 4330869, 01-03-17, Capas, Tarlac
IBP O. R. No. 1022022, 01-03-17, Tarlac Chapter FORM No. 4: JURAT
MCLE Compliance Certificate No.
V-0021747 until 04-14-2019 SUBSCRIBED AND SWORN to
Contact Nos. 0917-123-4567 before me this 24th day of March 2017 at
Tarlac City, Philippines, affiant exhibited to
-oOo- me his positive identification duly noted
above below his name and signature, known
FORM No. 2: SIGNATURE OF NOTARY to me and to me known to be the same person
PUBLIC who executed foregoing Affidavit and
acknowledged to me that the same is his free
ATTY. ANDREW B. CAYABYAB act and deed and that he voluntary executed
Notary Public-Province of Tarlac the same and understood all the contents
My Commission Expires December 31, 2017 thereof.
PTR No. 4330869, 01-03-17, Capas, Tarlac
IBP O. R. No. 1022022, 01-03-17, Tarlac Chapter WITNESS MY HAND AND SEAL.
MCLE Compliance Certificate No. V-
0021747 until 04-14-2019 (Signature of Notary Public)
-oOo- Doc. No. _____;
Page No. _____;
FORM No. 3: ACKNOWLEDGMENT Book No. ____;
Series of 2017.
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF TARLAC : S.S -oOo-
MUNICIPALITY OF BAMBAN )
FORM No. 5: AFFIRMATION or OATH
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
BEFORE ME, a Notary Public for and PROVINCE OF TARLAC : S.S
in the Municipality of Bamban, Province of MUNICIPALITY OF BAMBAN )
Tarlac, Philippines, this 29th day of March
2017, personally came and appeared JUAN
AFFIRMATION Certification/Police Blotter is attached as
Annex “A” to form an integral part hereof;
BEFORE ME, a Notary Public for
and in the Municipality of Bamban, Province 4. Since then, I tried to locate
of Tarlac, Philippines, this 17 th day of March and retrieved my said plastic envelope
2017, personally came and appeared JUAN containing my passport and SSS ID but all my
DELA CRUZ with Social Security System ID efforts were in vain;
No. 02-5549843-3, and who avowed under
penalty of law to the whole truth of the 5. I am executing this Affidavit
contents of the instrument or document he of Loss to attest to the truth of all the
presented to me. foregoing; to declare the said Philippine
Passport and SSS ID issued in my name as
WITNESS MY HAND SEAL. lost and null and void, and to request the
Department of Foreign Affairs and the Social
(Signature of Notary Public) Security System to issue a replacement for the
same;
Doc. No. _______;
Page No. _______; IN WITNESS WHEREOF, I have
Book No. ______; hereunto affixed my signature this 15 th day of
Series of 2017. March 2017 at Bamban, Tarlac, Philippines.
-oOo-
JOANNA L. DELANTAR
FORM No. 6: AFFIDAVIT OF LOSS Affiant
TIN: 476-405-759
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF TARLAC : S.S -JURAT-
MUNICIPALITY OF BAMBAN )
-oOo-
AFFIDAVIT OF LOSS
FORM No. 7: AFFIDAVIT OF SELF-
I, JOANNA L. DELANTAR, of ADJUDICATION OF SOLE HEIR OF
legal age, Filipino, single, with residence and DECEASED PERSON
postal address at No. 172, Brgy. Dela Cruz,
Bamban, Tarlac 2317, Philippines, after REPUBLIC OF THE PHILIPPINES)
having been duly sworn to in accordance with PROVINCE OF TARLAC : S.S.
law, do hereby depose and say: MUNICIPALITY OF CAPAS )
THAT— AFFIDAVIT OF SELF-ADJUDICATION
OF SOLE HEIR OF DECEASED
1. I am a holder of a Philippine PERSON
Passport issued by the Department of Foreign
Affairs, and a member of the Social Security I, JUANCHO A. PANCHO, of legal
System (SSS); age, Filipino, single, with residence and postal
address at Brgy. Sto. Domingo II, Capas,
2. On January 05, 2017 at around Tarlac 2315, Philippines, after having been
11:00 o’clock in the morning, while I was on duly sworn to in accordance with law, do
my way home from work, riding a public hereby depose and say:
utility jeepney route Mabalacat Gate,
Mabalacat City to Clark Freeport Zone, THAT—
Pampanga, I inadvertently lost my plastic
envelope containing my said passport and 1. I am the only surviving
SSS identification (ID) card after falling daughter of one of the late JESUS B. DAVID,
asleep; who died intestate on January 18, 2016 at
Concepcion, Tarlac, copies of my Certificate
3. On March 14, 2017, I reported of Live Birth and my late father`s Certificate
the loss of my passport and SSS ID before the of Death are attached as Annexes “A” and
Philippine National Police, Bamban, Police “B” both of which to form an integral part
Station, Bamban, Tarlac, a copy of the hereof;
2. Said Deceased left an estate 1. On March 01, 2016, JUAN DELA
consisting of two (2) parcels of land, CRUZ, of legal age, Filipino, single, with
containing an area of 2,462 square meters and residence and postal address at Tarlac City,
5,067 square meters, more or less, covered Philippines, sold to me a certain parcel of
and described by Transfer Certificate of Title land, covered and described by Transfer
No. 20950, issued by the Register of Deeds of Certificate of Title No. 123465, located at
Tarlac, which property is more particularly McArthur Highway, San Rafael, Tarlac City,
described as follows: with a right to repurchase the same within one
(1) year from said date, executed before
TRANSFER CERTIFICATE OF TITLE Notary Public Atty. Alvin Gado of Tarlac
No. 20950 City, which was entered into his notarial
registry under Document No. 11, Page 02,
(Technical Description of title) Book 15, Series of 2016;
3. Said deceased left no debts; 2. The said period expired on March 01,
2017 without said vendor of any other person
4. Pursuant to Rule 74, Sec. 1 of in his behalf having complied with the
the Rules of Court, I hereby adjudicate unto condition and stipulation refund for the
myself the above described parcels of land by repurchase of the said payment;
means of this Affidavit and hereby files same
with the Register of Deeds of Tarlac, with 3. The said period of repurchase has not
request that said adjudication be made been extended by affiant;
effective without judicial proceedings as
prescribed by the aforementioned Rules of 4. By virtue of said Deed of Sale with
Court; Pacto de Retro and by failure of the vendor to
duly repurchase the aforesaid property within
IN WITNESS WHEREOF, I have the period stipulated, there has been
hereunto affixed my signature this 29 th day of consolidated in the affiant as vendee a retro,
March 2017 at Capas, Tarlac, Philippines. the absolute ownership of the property;
ERLINDA T. DAVID 5. The Regional Trial Court, Third
Affiant Judicial Region, Branch 63, Tarlac City, has
TIN: 465-897-999 approved and confirmed the above
consolidation of ownership in the name of the
-JURAT- affiant on March 20, 2017, a certified copy of
the Decision is attached as Annex “A” to form
-oOo- an integral part hereof;
FORM No. 8: AFFIDAVIT OF 6. I am executing this Affidavit to attest
CONSOLIDATION OF OWNERSHIP IN to the truth of all the foregoing;
PACTO DE RETRO SALE
IN WITNESS WHEREOF, I have
REPUBLIC OF THE PHILIPPINES) hereunto affixed my signature this 24 th day of
PROVINCE OF TARLAC : S.S. March 2017 at Bamban, Tarlac, Philippines.
MUNICIPALITY OF BAMBAN )
AFFIDAVIT OF CONSOLIDATION JUANA CRUZ-GARCIA
OF OWNERSHIP IN PACTO Affiant
DE RETRO SALE PRC ID No. 0004385
Valid until: January 02, 2019
I, JUANA CRUZ-GARCIA, of legal
age, Filipino, married to ANGELO S. -JURAT-
GARCIA, with residence and postal address
at McArthur Highway, Brgy. Talaga, Capas, -oOo-
Tarlac 2315, Philippines, after having been
duly sworn to in accordance with law, do FORM No. 9: AFFIDAVIT OF GOOD
hereby depose and say: FAITH
THAT— AFFIDAVIT OF GOOD FAITH
We, the undersigned MORTGAGOR
AND MORTGAGEE hereby jointly and
severally swear that we executed the
foregoing Chattel Mortgage for the purpose of
securing the obligation/s specified in
the provisions hereof, and for no other
purpose and that the same is/are just valid
obligation/s and not entered into for the
purpose of fraud.
______________ ______________
Mortgagor Mortgagee
