Consolidation of Ownership in Pacto de Retro Sale AFFIDAVIT REPUBLIC OF THE PHILIPPINES ) CITY OF _____________________ ) S.S.

I, ______________________, of legal age, single/married, residing at __________________________, after being sworn to in accordance with law, depose and say: 1. That on ____________________,2 ___, Mr.________________ of legal age, Filipino, single/married to _______________________ residing at __________________________, sold to me a certain parcel of land under pacto de retro, executed before Notarial Public _____________ and bearing Not. Reg. No. ___, Page ___, Book __, Series of 2 _____ of his Notarial Register; 2. That a true copy of the said pacto de retro sale is hereto attached as ANNEX A; 3. That pursuant to said deed of sale with pacto de retro, the said vendor __________, should have exercised his rights to repurchase the said property within the period of ________ years; 4. That the said period expired on ___________; 5. That the said vendor, ___________________, by himself or by any other person in his behalf, has not complied with the condition and stipulation required for the repurchase of the said property; 6. That the said period of repurchase has not been extended, either expressly or impliedly, by affiant vendee a retro; 7. That by virtue of the said deed of sale with pacto de retro, and by the failure of the vendor, ______________ to duly repurchase the property therein mentioned within the period stipulated, there was consolidated in the affiant, as vendee a retro, the absolute ownership of the said property; 8. That attached hereto, as ANNEX B, is an order of the Regional Trial Court of _____________ issued on _________________, approving and confirming the above consolidation of ownership in the name of affiant.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of _______, 2__________, in the City of _______________, Philippines.

________________________ (Signature of affiant) JURAT