Republic of the Philippines)

Province of Cagayan)S.S.
Tuguegarao City
x-------------x

AFFIDAVIT OF ADVERSE CLAIM

WE, REBECCA CERIA, NORA CASTRO AND EVELYN ACEDO, all of legal
ages, Filipino, and residents of Lasam, Cagayan, after having been sworn to
in accordance with law, depose and say:

1. That we are three of the heirs of the late Lucena Tobias.

2. 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.

3. 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.

4. 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.

5. 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.
 6. 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.