Republic of the Philippines)

:
In the City of Pagadian)S.s.
x----------------------------------/
AFFIDAVIT OF ADVERSE CLAIM
I, ___________, Filipino of legal age, single and a resident of Santa Lucia District,
Pagadian City, after having duly sworn to in accordance with law do hereby deposes and say
that;
1. That I am an owner of a parcel of land, covered by TRANSFER CERTIFICATE OF
TITLE NO. ____, located at _________, Zamboanga del Sur, Island of
Mindanao and more particularly described as follows, to wit;
________________________________________________________
________________________________________________________
________________________________________________________
___________________________________________________
2. That I acquired the aforesaid land in GOOD FAITH from _______, Pagadian
City Branch, represented by its Branch Manager in the person of
____________, by virtue of a DEED OF ABSOLUTE SALE, dated
__________________, which was then registered as DOC. NO. __, PAGE
NO. ___ , BOOK NO. SERIES OF _____, before Notary Public ________, copy
hereto attached and marked as Exhibit A;
3. That after the execution of the Deed of Absolute Sale, however, due to financial
reverses, I was not able to register and cause the annotation of said deed of
conveyance before the Office of the Register of Deeds, Pagadian City. Neither I
processed for the transfer of ownership from the original registered owner in my
favor. Thus, the Certificate of Tile (TCT NO.__) of said land is still registered and
remained in the name of the original owner __________, copy of the land title
hereto attached and marked as Exhibit B
4. That sometimes on ______ 2008, I pledged the aforesaid land to _________,
Filipino of legal age and a resident of _____ Aurora, Zamboanga del Sur, in the
amount of ______________; I then temporarily turned over the Certificate of
Title (TCT NO.__) and the Deed of Absolute Sale, as a collateral and as a proof
and evidence of my capacity to mortgage the said land, copy of the Deed of Real
Estate Mortgage hereto attached and marked as Exhibit C;
5. That in 2013, I received an information that the land which I bought from
________, covered by ______, formerly registered in its original owner ____
was already transferred and registered in my name on ____________, which is
now covered by a new title, TRANSFER CERTIFICATE OF TITLE NO. ____,
copy hereto attached and marked as Exhibit D;
6. That instant, i was wondering then how come it was transferred and registered in
my name, when in the first place, I did not process and initiate for the transfer of
TCT NO and secondly, I temporarily turned over the owners duplicate original
copy of TCT ____ to mortgagor _________, as a collateral, which at present, I
presumed it was still in her possession;
7. That when I checked and verified the records from the Office of the Register of
Deeds, Pagadian City, I discovered that another purported Deed of Sale, dated
__________ was executed by __________, through its bank manager
__________ in my favor, which was then registered as DOC. NO, PAGE NO,
BOOK NO, SERIES OF 2013, before Notary Public ______, the very the same
notary public who subscribed and acknowledged the original Deed of Sale dated
_________, copy hereto attached and marked as Exhibit E;

8. I further discovered that I allegedly also executed another document

denominated as _____________, wherein I confirmed the deed of sale dated,
also subscribed and acknowledged before the same Notary Public __________,
copy hereto attached and marked as Exhibit F;
9. That without hesitation, I then filed a criminal complaint before the City
Prosecution Office, Pagadian City, against _________, which was then
docketed as __________ entitle, ___________ for ________, copy of the
Criminal Complaint together with its annexes and attachments hereto attached
and marked as Exhibit G;
10. That co-incidentally however, _______________, filed an Extra-judicial
______, before the Regional Trial Court Branch ____,which was then docketed
as _____, entitle _______, copy of the complaint, hereto attached and marked
as Exhibit H. in said latter case, _______ then, in one of the evidences
attached to the complaint, annexed a copy of the new TCT, duly registered in my
name. However, upon close scrutiny of said title (TCT No.__), the title number of
said certificate of title differs from the title number as originally appeared and
reflected in the Real State Mortgage dated _______; furthermore, the technical
description of the real property covered by TCT NO. is also entirely separate and
distinct and thus contradicts the technical description as those originally
reflected is said mortgage document, although it involved the same parcel of land
11. That in view of the peculiar surrounding circumstance involved, I hereby prayed
that any transaction which convey and/or transfer ownership of a parcel of land
covered by a former TCT NO, then registered in the name of _______, now
covered under a new TCT, presently registered in my name, should be HELD IN
ABEYANCE; and further prayed that this Affidavit of Adverse Claim be annotated
or cause it to be annotated in the TCT NO. itself
12. That I am executing this Affidavit of Adverse Claim to attest to the truth and
veracity of the foregoing statements and for legal purpose this may serve.
SUBSCRIBED AND SWORN TO before me this ___th day of January 2016, at
Pagadian City, Zamboanga del Sur, Philippines.
_____________
Affiant
I.D. NO. _______________
Issued by ______________