LTC Form No.
Republic of the Philippines ) LTC Application No. ____
City /Municipality of _____ )S.s
Province of _____________ )
APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCE
WE, _________________________ and __________________________, both of legal age,
Filipino citizens, married/single and residents of _________________________________, after
being sworn in accordance with law, hereby depose and state:
1. We are the parties in a _______________________ involving a parcel of land covered by
TCT / OCT No. _______, with Lot No. ____________, Survey No. ______, with an area of
_________ (hectares), more or less, and located at ____________________________ or
declared under Tax Declaration (TD) No. ________;
2. This application for the issuance of Land Transfer Clearance (LTC) is not contrary to law because
both of us are qualified to dispose and acquire the land described above. In addition, the said land
is neither covered under the agrarian reform program nor within the CARPER LAD Balance, and
that the deed/contract will not violate the retention limit provided under the law;
3. In support thereto and in compliance with DAR A.O. No.4, Series of 2021, the mandatory
documents are hereto attached and made integral parts hereof as (please check appropriate box):
3.1 FOR THE TRANSFEROR:
Official Receipt : Annex ___
Electronic Copy of the Title : Annex ___
Deed or document to be registered : Annex ___
Affidavit of Aggregate Landholding : Annex ___
Affidavit of Retention, Non- Tenancy / tenancy with : Annex ___
Compliance of tenant’s right of Pre-emption and/or
Redemption and no pending case before the land
subject of the transaction, if there is a case before
the regular courts or any other tribunal the same had
been decided with finality or Affidavit of transferee in
the case of extrajudicial settlement
City Assessor’s Certificate of Aggregate Landholding : Annex ___
Provincial Assessor’s Certificate of Aggregate : Annex ___
Landholding
Provincial or City Assessor’s Certificate if not a resident of
Batangas Province : Annex ___
3.2 FOR THE TRANSFEREE:
Affidavit of Aggregate Landholding : Annex ___
LTC Form No. 1
City Assessor’s Certificate of Aggregate Landholding : Annex ___
Provincial Assessor’s Certificate of Aggregate : Annex ___
Landholding
Municipal Agrarian Reform Program Officer : Annex ___
Certification (LTC Form No.2)
Provincial or City Assessor’s Certificate if not a resident of
Batangas Province :Annex ___
Special Power of Attorney (if applicable) :Annex ___
Secretary’s Certificate (in case of a corporation) :Annex ___
4. Having submitted/attached hereof the mandatory documents as required under DAR A.O. No.4,
Series of 2021, I/we hereby file this instant application/request to facilitate the issuance of the
corresponding Certificate on LTC.
IN WITNESS WHEREOF, we have hereunto set our hands this ____ day of ____ 20 ___ at
_____________, Philippines.
____________________________________ _____________________________________
Applicant Applicant
ID No. _________________ ID No. _________________
Date Issued: ____________ Date Issued: ____________
Place Issued: ___________ Place Issued: ____________
SUBSCRIBED AND SWORN to before me this ____ day of ____20____at ___________,
affiants upon exhibiting to me their duly issued government IDs with details stated above.
NOTARY PUBLIC
Doc No. ______;
Book No. _____;
Page No. _____;
Series of 20 ___
Copy Distribution:
Original – DARPO / LTC Folder
Duplicate - Applicant
