REPUBLIC OF THE PHILIPPINES )
___________________________) S.s.
CITY OF __________________ )
                                    AFFIDAVIT
      I,____________________,       with       office       address       at
___________________________, after having been duly sworn in accordance with
law, do hereby depose and state:
1. That I am the petitioner for the administrative reconstitution of Original/
Transfer Certificate of Title (TCT/OCT) No. _____ which describe and
cover a parcel of land registered to __________, ET. AL., particularly
designated as ___________, with an area of ______________________________
(____________ sq.m.) SQUARE METERS, more or less, and located in
Barangay ______________________;
2. That the above-described parcel of land was awarded and registered to
__________________, ET. AL., by virtue of the ______________
3. That the land described and covered under Original /Transfer
Certificate     of    Title     (OCT/TCT)  No. _____, is subject
to________________________________________
4. That ROD File of the aforesaid Original/ Transfer Certificate of Title
(OCT/TCT) No. _____, on file with the Registry of Deeds of _____, was
lost/destroyed due to fire;
5. That the Owner’s Duplicate Copy (ODC) of the aforesaid Original /
Transfer Certificate of Title (OCT/TCT) No. ________, is existing and was
already surrendered to the___________;
6. That while the land described and covered under Original / Transfer
Certificate of Title (OCT/ TCT) No. _____, is already under possession and
tillage of the _________, the subject land remains under administration of the
______________________________
7. That, furthermore, the earlier-mentioned ___ are still under obligation to
pay amortizations to the Land Bank of the Philippines (LBP), and under
obligation to comply with the continuing qualification as an___;
8. That as the ______________, I have the legal standing to file the above-
stated administrative reconstitution of Original / Transfer Certificate of
Title (OCT/TCT) No.__________, which is an indispensable requirement
before individual titles may be generated and awarded to respective_______;
9. That I hereby attest to the truthfulness and veracity of the foregoing
statement freely and voluntarily without being coerced or intimidated by
anyone.
10. FINALLY, that I am executing this affidavit for whatever legal purposes it
may serve.
      IN WITNESS WHEREOF, I             hereby   affixed   my   signature   this
_____________, at __________________.
                                          _________________
                                                 Affiant
                                          ID NO.__________
      SUBSCRIBED AND SWORN to me before this ___________________ at
______________.
                                                           NOTARY PUBLIC
Doc No. _______;
Page No. _______;
Book No. _______;
Series of ____