I, _________________, of legal age, Filipino, married to ____________, and a resident of ____________________, after having been duly sworn to pursuant to law, depose and say:
1. That I own only an aggregate landholding in the whole country an area of not more than FIVE (5) hectares of agricultural land, to include that area of ______, which parcels of land I acquired from ________________.
2. That this affidavit is executed in compliance with DAR Administrative Order No. 01, S – 1989 as well as to show proof that my total aggregate agricultural landholding inclusive of the land subject of the abovementioned transaction does not exceed five (5) hectares.
IN WITNESS HEREOF, I have hereunto set my hand this ___________ in _______________