Form No.

1120
Republic of the Philippines)
______________________) S.S.
AF FI D AV I T
I, _________________________________, Filipino, of legal age, Single/Married,
with postal address and residence at __________________________________________,
after being sworn to in accordance with the law do hereby depose and state the following:
1. That I am the ______________________ of __________________________,
(State Position)
(Name of Corporation)
registered owner of certain parcel(s) of land located at __________________
covered by Original Certificate of Title/Transfer Certificate of Title No.(s)
_______________________________;
2. That the above-mentioned property/ies is/are the subject of application for
Registration and License to Sell for the proposed ______________________
(Project Name)
now pending with the Housing and Land Use Regulatory Board (HLURB);
3. That to the best of my knowledge, said property/ies is/are free from liens and
encumbrances;
4. That in the event said property/ies shall be mortgaged to any person, natural or
judicial, I hereby undertake to nullify and secure the approval of the Housing
and Land Use Regulatory Board (HLURB) prior to such mortgage;
5. Thai I am executing this Affidavit to attest to the veracity of the abovementioned facts thereby satisfying the requirements of the Housing and Land
Use Regulatory Board (HLURB) relative to my application for Registration
and License to Sell for the above-mentioned project.
Affiant further says nothing.
____________________, 200__, __________________________, Philippines.
______________________________
Affiant
SUBSCRIBED AND SWORN to before me in this _____ day of ____________
200_; affiant exhibiting to me his/her Residence Certificate No. __________________
issued at ________________________ on ______________________.

NOTARY PUBLIC
Doc. No. _________
Page No. _________
Book No. _________
Series of _________