Republic of the Philippines )
Municipality of ____________ ) S.S.
Province of ________________ )
AFFIDAVIT
I, ________________________________________________ of legal age, residing at
_______________________________________________________________, after having been duly
sworn to in accordance with Law, do hereby depose and state of the following:
That, I am executing this affidavit to give permit to the
___________________________________________________________________________________ to
ENTER AND CONSTRUCT ROADS in the affected lot under TCT NO. _______________ Tax
Declaration No. ___________________ in connection with the
_____________________________________________________________________________________
_____________________________________________________________________________________
to be undertaken by the
__________________________________________________________________.
That, I am the owner/claimant/occupant over the affected lot.
That, I am executing this affidavit to attest to the truthfulness of the foregoing and for whatever legal
purpose this statement may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________________________,
in _______________________________________, Philippines.
__________________________
(Affiant)
SUBSCRIBED AND SWORN to before me this ________________________________, affiant exhibited
to me his/her ___________________________________ no. ____________________________ issued on
____________________________ at ______________________________, Philippines.
Doc. No.: __________
Series of 2019