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Republic of the Philippines

Court of First Instance of _________________

The undersigned,
____________________________________________________________hereby applies
(or apply) to have the land hereinafter described brought under the operation of the
Property Registration Decree, and to have the title thereto registered and confirmed:
AND DECLARE . . . . .
1. That the applicants/s is/are the owners of the land (by virtue of inheritance or
deed of sale or conveyance and/or possession in accordance with Section 14 of
said Decree), together with the building and improvements thereon, with the
exception of the
following:_________________________________________________________
_________ which is/are the property of _________________________ residing at
_________________________ The said land, consisting of
____________________ parcel/s is/are situated, bounded and described as shown
on the plan and technical descriptions attached hereto and made a part hereof,
with the following
exception:_________________________________________________________
__________
2. That said land at the last assessment for taxation was assessed at P ____,
Philippine currency, and the buildings and other improvements at P ___________,
Philippine currency.
3. That to the best of my/our knowledge and belief, there is no mortgage or
encumbrance of any kind whatsoever affecting said land, nor any other person
having any interest therein, legal or equitable, or in possession, other than as
follows:
_________________________________________________________________
______________
4. That the applicant/s has/have acquired said land in the following manner:
________________________________
(Note: Refer to Sec. 14 of said Decree. State also whether the property is
conjugal, paraphernal or exclusive property of the applicant/s)
5. That said land is occupied by the following person:
_________________________________________________________________
___________

6. That the names in full and addresses, as far as known to the undersigned, of the
owners of all adjoining properties, of the persons mentioned in paragraphs 3 and
5, and of the persons shown on the plan as claimants, are as follows:
_________________________________________________________________
_______________________
7. That the applicant/s is/are single or married to ____________________ (Note:
if marriage has been legally dissolved, state when and how the marriage relation
terminated.)________________________________________________________
_________ _____________________
8. That the applicant's/s' full name, age, citizenship, residence, and postal
address/es is/are as follows:
_________________________________________________________________
__
9. That (Note: If the land included in the application is bounded by a public or
private way or road, there should be stated in this paragraph whether or not the
applicant claims any and what land within the limits of the way or road and
whether the applicant desires to have the line of the way or road determined.)
________________________________________
___________________________
10. That the following documents are attached hereto and made a part hereof:
___________________________________
________________________________
Signed at ___________________ this _____________________ day of
____________________, in the year nineteen hundred and
______________________.

_________________________
Applicant
_________________________
(Post Office Address)

REPUBLIC OF THE PHILIPPINES


PROVINCE (OR CITY) OF _______________

On this _______________ day of _________________________,19 ________


personally appeared before me the above- named
__________________________________________________ known to me to be the
person/s who executed the foregoing application and made oath that the statements
therein are true of his/their knowledge, information and belief.
The Residence Certificate/s ______________________ of the applicant/s
______________ was/were exhibited to me being No. _________________ issued at
___________________ dated ____________, 19 __________.

________________________
(Notary Public, or other Officer
authorized to administer oaths)
PTR NO. _________________

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