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(Adverse Claim for Transferred Rights over Real Property)

Republic of the Philippines)


Province of ________________)S.S.
City/Municipality of _____________)
x-------------x

AFFIDAVIT OF ADVERSE CLAIM

I, _____________, of legal age, Filipino, (single / married / widow), and a resident of


_____________, after having been sworn to in accordance with law, depose and say:

That I am one of the heirs of the late _____________.

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 _____________, more
particularly described as follows:

(Technical Description of Property) That on _____________, _____________ executed


a (Deed of Transfer of Rights / Assumption of Obligations) in favor of the late
_____________, which document is more particularly identified as Document No.
______, Page No. ______, Book No. ______, Series of ______ in the Notarial Register
of Notary Public _____________ and a copy of which is attached herein.

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 in the purchase of the aforedescribed parcel of land.

That as such, _____________ has since then relinquished all his rights, interest and
participation over the aforedescribed parcel of land in favor of the late _____________
and his heirs.

However, it has come to my knowledge that _____________ is presently claiming to still


have an interest over the aforementioned parcel of land and is attempting to sell or
dispose of the same despite the fact that he has already conveyed all his rights and
interests thereon to _____________ and his heirs.

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 this Affidavit in support of my request for the annotation of an adverse claim
over the parcel of land described herein.
FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________, in the City
/ Municipality of _____________, Philippines.

Affiant

(JURAT)

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