(Adverse Claim for Transferred Rights over Real Property)

Republic of the Philippines)

Province of ________________)S.S.
City/Municipality of _____________)
x-------------x

AFFIDAVIT OF ADVERSE CLAIM

I, _____________, of legal age, Filipino, (single / married / widow), and a resident of

_____________, after having been sworn to in accordance with law, depose and say:

That I am one of the heirs of the late _____________.

That a certain _____________ previously entered into a Deed of Conditional Sale with the
(Government Service Insurance System (GSIS) or Pag-IBIG) for the purchase of a parcel of land
(including the improvements thereon) located at _____________, more particularly described as
follows:

(Technical Description of Property) That on _____________, _____________ executed a (Deed of

Transfer of Rights / Assumption of Obligations) in favor of the late _____________, which
document is more particularly identified as Document No. ______, Page No. ______, Book No.
______, Series of ______ in the Notarial Register of Notary Public _____________ and a copy of
which is attached herein.

That in said (Deed of Transfer of Rights / Assumption of Obligations), _____________, for valuable
consideration received, ceded, transferred and conveyed to _____________, his heirs, successors
and/or assigns, all his rights, interest and participation in the purchase of the aforedescribed parcel of
land.

That as such, _____________ has since then relinquished all his rights, interest and participation
over the aforedescribed parcel of land in favor of the late _____________ and his heirs.

However, it has come to my knowledge that _____________ is presently claiming to still have an
interest over the aforementioned parcel of land and is attempting to sell or dispose of the same
despite the fact that he has already conveyed all his rights and interests thereon to _____________
and his heirs.

That unless an adverse claim is annotated on the aforedescribed Transfer Certificate of Title, the
heirs of _____________ are in danger of being defrauded and deprived of their just and valid right
over the aforedescribed parcel of land and, as such, I am executing this Affidavit in support of my
request for the annotation of an adverse claim over the parcel of land described herein.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________, in the City /
Municipality of _____________, Philippines.

Affiant

(JURAT)