Republic of the Philippines Regional Trial Court of _________________ The undersigned, ____________________________________________________________hereby applies (or apply) to have the land hereinafter described brought under the operation of the Property Registration Decree, and to have the title thereto registered and confirmed: AND DECLARE . . . . . 1. That the applicants/s is/are the owners of the land (by virtue of inheritance or deed of sale or conveyance and/or possession in accordance with Section 14 of said Decree), together with the building and improvements thereon, with the exception of the following:__________________________________________________________________ which is/are the property of _________________________ residing at _________________________ The said land, consisting of ____________________ parcel/s is/are situated, bounded and described as shown on the plan and technical descriptions attached hereto and made a part hereof, with the following exception:___________________________________________________________________ 2. That said land at the last assessment for taxation was assessed at P ____, Philippine currency, and the buildings and other improvements at P ___________, Philippine currency. 3. That to the best of my/our knowledge and belief, there is no mortgage or encumbrance of any kind whatsoever affecting said land, nor any other person having any interest therein, legal or equitable, or in possession, other than as follows: _______________________________________________________________________________ 4. That the applicant/s has/have acquired said land in the following manner: ________________________________ (Note: Refer to Sec. 14 of said Decree. State also whether the property is conjugal, paraphernal or exclusive property of the applicant/s) 5. That said land is occupied by the following person: _____________________________ ______________________________________________ 6. That the names in full and addresses, as far as known to the undersigned, of the owners of all adjoining properties, of the persons mentioned in paragraphs 3 and 5, and of the persons shown on the plan as claimants, are as follows: ________________________________________________________________________________________ 7. That the applicant/s is/are single or married to ____________________ (Note: if marriage has been legally dissolved, state when and how the marriage relation terminated.)_________________________________________________________________ _____________________ 8. That the applicant's/s' full name, age, citizenship, residence, and postal address/es is/are as follows: ___________________________________________________________________ 9. That (Note: If the land included in the application is bounded by a public or private way or road, there should be stated in this paragraph whether or not the applicant claims any and what land within the limits of the way or road and whether the applicant desires to have the line of the way or road determined.) ________________________________________ ___________________________10. That the following documents are attached hereto and made a part hereof: ___________________________________ ________________________________ Signed at ___________________ this _____________________ day of ____________________, in the year nineteen hundred and ______________________. __________________________ Applicant _________________________ (Post Office Address)