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I, ________________________, of legal age, Filipino, married ,and aresident of _____________________, after having been sworn to in accordance with law,depose and say:
1. That I am one of the heirs of the late ____________________________

who died last ______________________;

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 Mabini, Cebu City , more particularly described as follows: (Technical Description of Property)

3. That on _____________ , _____________ executed a(Deed of Transfer of Rights / Assumption of Obligations)in favor of the late _____________ , which document is more particularly identified asDocument No. ______ , Page No. ______ , Book No. ______ , Series of ______ in the Notarial Register of Notary Public _____________ and acopy of which is attached herein. 4. 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 inthe purchase of the aforedescribed parcel of land. 5. That as such, _____________ has since then relinquished all his rights,interest and participation over the aforedescribed parcel of land infavor of the late _____________ and his heirs. 6. However, it has come to my knowledge that _____________ is presentlyclaiming to still have an interest over the aforementioned parcel of landand is attempting to sell or dispose of the same despite the fact that hehas already conveyed all his rights and interests thereon to _____________ and his heirs.
7. 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 thisAffidavit in support of my request for the annotation of an adverse claim over the parcel of land described herein. IN WITNESS WHEREOF, I have set my hand this 1st day of March, 2012, in Cebu City, Philippines. _________________________________ AFFIANT

SSS I.D. No. _________________________ Issued at Cebu City SUBSCRIBED AND SWORN to before me, this 1st day of March, 2012 by the Affiant whom I have identified through competent evidence of identity and who exhibited her Government Issued Identification Number as per description appearing below her name.

Doc No.: _____; Page No.: _____; Book No.: _____; Series of: 2012.