Republic of the Philippines)
______________ ) S.S.
x--------------------------------x
AFFIDAVIT OF TRANSFEROR
I, _________________, of legal age, Filipino, single/married to ____________, and with
residence/postal address at ____________________, after having been duly sworn in accordance
with law, hereby depose and state:
1. That the land I sold to _______________, which represents a portion of my retention area
under Katibayan Ng Orihinal Na Titulo Blg. _____ Lot No. ______ with an area of (area in
words) (area in numbers) square meters, more or less, by virtue of Deed of Absolute Sale
recorded under Doc. No. _____, Page No. _____, Book No. _____, Series of _____, of the
Notary Public Atty. ________________ dated (month/day/year) is a portion of my retention
area of not more than five (5) hectares.
2. That the above subject portion of land is not worked by any tenant or agricultural lessee.
3. That this affidavit is executed in compliance with DAR Administrative Order No. ____,
series of _____, as well as to show proof that land subject of the above mentioned transaction
is a portion of my retention area.
4. That there is no pending case before the regular courts or any other tribunal involving the
land subject of the transaction.
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of _________
2023 in _______________________, Philippines.
__________________
Affiant
SUBCRIBED AND SWORN TO before me this ______ day of ________ 2023 in
______________, Philippines, affiant exhibiting to me his valid proof of identification
_____________________.
Notary Public
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2023.
ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES)
________________ ) S.S.
BEFORE ME, a Notary Public for and in the above jurisdiction, personally appeared
______________ with _________________ issued on ___________ at _____________, known
to me and to me known to be the same person who executed the foregoing instrument and
acknowledged to me that the same is their own free will and voluntary act and deed.
This instrument consists of the ________ (____) pages including this page wherein this
Acknowledgement is written, and is signed by the parties and their instrumental witnesses on
each and every page hereof.
WITNESS MY HAND AND SEAL, this _____ day of __________, 2023 at
________________, Philippines.
NOTARY PUBLIC
Doc. No. ________
Page No. ________
Book No. ________
Series of 2023.