REPUBLIC OF THE PHILIPPINES)
CITY OF ILOILO ) S.S.
x-------------------------------------x
I, _________________, of legal age, Filipino citizen, single/married/widowed and presently residing at _____________________, after having been duly sworn to in accordance with law, do hereby depose and say:
That I am the registered owner of a parcel of land situated at Brgy. Cubay, Miag-ao, Iloilo containing an area of TWENTY THOUSAND TWO HUNDRED (20,200) square meters, more or less, covered by Transfer Certificate of Title No. 12345 of the Register of Deeds of Iloilo City;
That I hereby state that the above-mentioned property has no existing improvements of whatever kind and nature and it remained idle up to the present;
That I am executing this affidavit to attest to the truth of the foregoing facts and for whatever legal intents and purposes that it may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________ 20____ in ____________, _____________, Philippines.
___________________________________
Affiant
SUBSCRIBED AND SWORN TO before me this _____ day of _________ at ________________ affiant exhibited to his/her competent evidence of identity by way of _________________ issued on __________________ in _______________, Philippines.
Notary Public
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of ______;