Department of Agrarian Reform

Annex A
DEPARTMENT OF AGRARIAN REFORM

CANCELLATION FORM NO. 1
A.O. NO.______. SERIES OF 2018
APPLICATION FOR CANCELLATION
I, _______________________________________, Filipino, of legal age, married/single, with

resident at ________________________________, do hereby request for the Cancellation of the
following titles, thus:
EP/CLOA/TITLE No. REGISTER OF DEEDS AREA REGISTERED LOCATION

OWNER
_______________ _______________ _____ ___________ __________
_______________ _______________ _____ ___________ __________
_______________ _______________ _____ ___________ __________
A. Based upon the existence of a Final and Executory Decision in
Docket No.: ____________________________

Case Title: ____________________________
Parties: ____________________________
Office/Court: ____________________________
Date of Decision: ____________________________
Date of Finality: ____________________________
OR
B. Based upon the need to correct the entries in the aforesaid titles which do not affect the
identity or number of agrarian reform beneficiaries or the size and scope of the landholdings
under the said title.
OR
C. Based upon the transfer of title on the basis of a conveyance approved through a valid DAR
transfer clearance
OR
D. Based upon the motion of the petitioner/s or the parties to withdraw the Cancellation Action.
I am hereby attaching the following documents to support my request:
1.0 Certified True Copy of the Decision of the Court/Office.

2.0 Certification that the Decision has become Final and Executory issued by the Court/Office.
3.0 The motion to Dismiss or Withdraw in Case No. ____________________ pending at
________________ docketed as __________________.
4.0 The DAR Transfer Clearance.
5.0 The Corrected Technical Description of the concerned EP/CLOA/Agrarian Reform Title Certified
as true and correct by the BLTI.
6.0 The most recent certified true copy of the subject EP/CLOA/other title.
7.0 Proof of receipt by the registered owner/s of the EP/CLOA or other title of the Application for
Cancellation.
I hereby certify under oath that all statements I made in this request are true and correct based on my
personal knowledge and that all documents attached are authentic.
Name: _______________________________
Signature: ______________________________
SUBSCRIBED AND SWORN to before me this ______ day of ______________, 2018 in

__________________________________, Philippines.
Doc. No.____
Page No.____ Notary Public
Book No.____
Series No.___
Annex B

PARPO II ACKNOWLEDGMENT RECEIPT
I have examined the application form and the attachments and found them compliant with the
requirements under the Rules of Summary Procedure.
I Request for Cancellation has Cancellation Application Number.
03-16-001(Region-Year-0001)
I acknowledge receipt of the following documents:
___ 1. The Certified True Copy of the Decision in the case docketed as ___________ before the
Court/Office _____________________ and signed by __________________.
___2. The Certification that the Decision has become Final and Executory on ____________ as
Certified by ___________________ of the Court/Office of _______________.
___3. The Motion to Dismiss/Withdraw the Cancellation Action signed by the petitioner/s or all
Parties in Case No. _______________ and docketed as _________________.
___4. The DAR Transfer Clearance indicating date of issuance and issuance number.
___5. The Corrected Technical Description approved by the BLTI.
___6. The most recent certified true copy of the subject EP/CLOA/Other title.
___7. Proof of receipt by the registered owner/s of the EP/CLOA or other title of the Application for
Cancellation.
I certify that I received the Application Form and the attachments on

________________at____________ AM/PM
Name of PARPO II: ____________________

Date: ____________________
Signature: ____________________
Annex C

PARPO II RECOMMENDATION
The undersigned hereby recommends the Cancellation of the following titles (Withdrawal of the
Cancellation Case):

OWNER
_______________ _______________ _____ ___________ __________
_______________ _______________ _____ ___________ __________
_______________ _______________ _____ ___________ __________
The recommendation is based on the determination that the aforesaid titles must be cancelled
to comply with the Decision in the following case:
Docket No.: ____________________________

Case Title: ____________________________
Office/Court: ____________________________
Date of Decision: ____________________________(Excluded if recommendation is to
Date of Finality: ___________________________ terminate case upon joint motion)
The recommendation is based upon the following documents:
1. Certified True Copy of the Decision

2. Certification of Finality of the Decision
3. (Motion to Dismiss the Case)
4. The most recent certified true copy of the subject EP/CLOA/other title.
5. Proof of receipt by the registered owner/s of the EP/CLOA or other title of the Application
for Cancellation.
The recommendation is based on the approved transfer of title on the basis of DAR Transfer
Clearance dated _______________ with Issuance No. _______________.
Certified true and correct.
Name of PARPO II: ____________________

Date: ____________________
Signature: ____________________
Annex D

CANCELLATION FORM NO. 3A
PARPO II RECOMMENDATION
The undersigned hereby recommends the Cancellation of the following titles (Withdrawal of the
Cancellation Case):

OWNER
_______________ _______________ _____ ___________ __________
_______________ _______________ _____ ___________ __________
_______________ _______________ _____ ___________ __________
The recommendation is made based on the need to change the technical description in the
aforesaid titles in the following manner:
Title No. 1 _________________________________

_________________________________
_________________________________
Title No. 2 _________________________________

_________________________________
_________________________________
Title No. 3 _________________________________

_________________________________
_________________________________
The recommendation is based upon the New and Approved Technical Description(s) provided by
the BLTI which is attached to the Application for Cancellation.
Certified true and correct.
Name of PARPO II: ____________________

Date: ____________________
Signature: ____________________
Annex E

ORDER OF CANCELLATION
This is to certify that the following title/s bearing the following descriptions, thus:
Title No.: ______________________

Issued by: ______________________
Location: ______________________
Area: ______________________
Owner: ______________________
Is/are hereby being CANCELLED on the basis of the following ground/s:
1.0 Final and Executory ALI Case
Case No.: ____________________________

Title: ____________________________
Office/Court: ____________________________
Date of Decision: ____________________________
Date of Finality: ____________________________
(Based on documents attached to Cancellation Form No. _______)
OR
2.0 Change in Technical Description as approved by the BLTI which does not affect the
number or identities of ARBs or the area and location of the landholdings based on
the documents attached to Cancellation Form No. ______.
OR
3.0 Issuance of new title due to a conveyance on the basis of a DAR Transfer Clearance
dated _______________ with Issuance No. _____________.
OR
4.0 This is to certify that Case No. ________ entitled ____________________before

____________ is hereby being dismissed on the basis of Motion to Withdraw the
Action filed by the petitioner/s or the parties (Based on the document attached to
Cancellation Form No. ______).
The PARPO II is hereby instructed to furnish a copy of the Order of Cancellation to the Agrarian Reform
Beneficiaries adversely affected by the cancellation of the title.
________________________
Secretary

Department of Agrarian Reform

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Annex A

DEPARTMENT OF AGRARIAN REFORM

APPLICATION FOR CANCELLATION

I, _______________________________________, Filipino, of legal age, married/single, with

EP/CLOA/TITLE No. REGISTER OF DEEDS AREA REGISTERED LOCATION

A. Based upon the existence of a Final and Executory Decision in

Docket No.: ____________________________

I am hereby attaching the following documents to support my request:

1.0 Certified True Copy of the Decision of the Court/Office.

SUBSCRIBED AND SWORN to before me this ______ day of ______________, 2018 in

DEPARTMENT OF AGRARIAN REFORM

PARPO II ACKNOWLEDGMENT RECEIPT

I Request for Cancellation has Cancellation Application Number.

I acknowledge receipt of the following documents:

___5. The Corrected Technical Description approved by the BLTI.

I certify that I received the Application Form and the attachments on

Name of PARPO II: ____________________

DEPARTMENT OF AGRARIAN REFORM

EP/CLOA/TITLE No. REGISTER OF DEEDS AREA REGISTERED LOCATION

Docket No.: ____________________________

The recommendation is based upon the following documents:

1. Certified True Copy of the Decision

Certified true and correct.

Name of PARPO II: ____________________

DEPARTMENT OF AGRARIAN REFORM

EP/CLOA/TITLE No. REGISTER OF DEEDS AREA REGISTERED LOCATION

Title No. 1 _________________________________

Title No. 2 _________________________________

Title No. 3 _________________________________

Certified true and correct.

Name of PARPO II: ____________________

DEPARTMENT OF AGRARIAN REFORM

Title No.: ______________________

Is/are hereby being CANCELLED on the basis of the following ground/s:

1.0 Final and Executory ALI Case

Case No.: ____________________________

4.0 This is to certify that Case No. ________ entitled ____________________before

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SUBSCRIBED AND SWORN to before me this day of ________, 2018 in

4.0 This is to certify that Case No. entitled ____________before