Downloadable Forms at: www.dar.gov.

ph free of charge

CARPER LAD Form No. 67

(New)

Republic of the Philippines

DEPARTMENT OF AGRARIAN REFORM
Region No. ______
Province of _________________
Municipality of ___________

REPORT ON ARB’s FAILURE TO TAKE POSSESSION OF AWARDED LAND

______________
Date
MEMORANDUM

FOR : ____________________________
Provincial Agrarian Reform Officer II

FROM : ____________________________
Municipal Agrarian Reform Officer

SUBJECT : Report that the ARBs are unable to take possession of their awarded land

This is to inform you that the following ARBs are unable to take possession of their awarded land as follows:

Name of ARB CLOA-Title Area Lot No. and Location

(Last Name, First Name, Middle No. (sq. Survey No. (Municipality,
Initial) meters) Barangay)

(Use additional sheets if necessary)

Their failure to take possession was brought about by threats, harassment and intimidations inflicted against
their person and their immediate farm household, putting them physically in danger and mentally disturbed.

In this connection, it is respectfully recommended that a Writ of Installation be issued by your office in order to
protect the rights of our ARBs.

For your favorable consideration.

_____________________________
Municipal Agrarian Reform Officer
(Signature over printed name)

Copy Distribution
Original - DARPO
Duplicate - DARMO/File

CARPER LAD Form No. 67/ Page 1 of 2

Downloadable Forms at: www.dar.gov.ph free of charge

CARPER LAD Form No. 67

(New)

ADDITIONAL SHEET FOR LIST OF ARBs WHO ARE UNABLE TO TAKE POSSESSION OF THEIR AWARDED LAND

Name of ARB CLOA-Title Area Lot No. and Location

(Last Name, First Name, Middle No. (sq. Survey No. (Municipality,
Initial) meters) Barangay)

Note: Put a big “X” in the row immediately after writing/typing/encoding the name of the last ARB in the list.
Then put the words “NOTHING FOLLOWS”. Use additional sheet, if necessary. Each additional sheet should be
initialed by the MARO.

CARPER LAD Form No. 67/ Page 2 of 2