2022 Fpa App Form Blank

Republic of the Philippines
Department of Environment and Natural Resources

Cordillera Administrative Region
Community Environment and Natural Resources Office-Buguias
Km. 21, Caliking, Atok, Benguet
e-mail Address: [email protected]
APPLICATION FOR AGRICULTURAL FREE PATENT

(Under Chapter VII of CA 141, as amended, and R.A. No. 11573)
Lot No. :_______________________ Location

Survey No.: ____________________ Barangay: _________________________
Area: __________________________ Municipality: _________________________
Province: _________________________
Applicant’s Information
Name: __________________________________________________________________
(Last Name) (First Name) (Middle Name)
Birthday: _______________________
Sex: Male Female 
Age: ___________________________
Mailing Address: __________________________________________________________
Civil Status: Single Married  Divorced  Separated  Widowed
Name of Spouse (if married): ________________________________________________
Citizenship: __________________________ Natural-born Citizen: Yes No 
Mobile: ______________________________
Email Address: ________________________
1. I am not an owner of more than 12 hectares of land.

2. I have not filed any petition for judicial titling on the same subject lot.
3. I entered upon and began cultivation of the same on __________________
(dd/mm/yyyy), and since then, I have continuously cultivated the land; and have made
thereon the following improvements;
________________________________________________________________________
________________________________________________________________________
4. (Optional, if the applicant is a transferee)
The land described and applied for is not claimed or occupied by any other person but is
public land which was first occupied and cultivated by
___________________________on____________________.
5. (Optional, if the applicant is an heir)
The previous cultivator, _______________________________ who was my ancestor,

died on ___________________. Since his/her death, I have cultivated the said land
and existing improvements thereon which consists of the following:
_____________________________________________________________________
_____________________________________________________________________
_______________________________________________________________
Evidence of relationship, death, burial, and heirship is hereto attached and consists of
_____________________________________________________________________
____________________________________________.
The following are the names and addresses of the heirs of my ancestor
Name Address
1.___________________________ _______________________________
2. __________________________ _______________________________
3.___________________________ _______________________________
6. I am________________________, the only heir/representative of the heirs of ________

_________________entitled to succeed him/her according to the laws of the Philippines.
7. The land has been continuously occupied and cultivated by me or my said ancestor
since the date of entry thereon as above stated, except during the following period,
when the land was not occupied for the reason stated:
_____________________________________________________________________
8. To the best of my knowledge, information and belief, the land applied for is an
alienable and disposable public agricultural land suitable for agricultural purposes.
9. I agree to demarcate applicable easements consistent with the existing policies and
regulations.
10. The following two (2) disinterested persons named witnesses testify that the
allegations in this application are true:
Name and Signature Address
1. _________________________ ________________________
_
CTC/Gov’t Issued ID _________________________ ________________________
& No.
_
2. _________________________ ________________________
CTC/Gov’t Issued ID _________________________ _
& No.
________________________
_
11. I understand that any applicant who willfully and knowing submit false statements or
executes false affidavits in connection with this application shall be deemed guilty of
perjury and that any person who, not being qualified to apply for public lands, files an
application or induces or permits another to file it on his/her behalf shall be punishable
in accordance with existing laws. His/her application shall be rejected or cancelled and
all amount paid on account thereof shall be forfeited in favor of the Government, and
she/he shall not be entitled to apply for any public land in the Philippines.
_________________
Applicant’ Name and Signature
AFFIDAVIT
(Republic of the Philippine
Province of Benguet : S.S
Municipality of ____________)
The person making the foregoing application under oath depose and say:
That I have read, or someone has read to me, and I thoroughly understand the foregoing
application and that I signed the same and this affidavit in the presence of the officer who
administered the oath; and that each and every statement in the application is true and
correct.
_________________________
Applicant’ Name and Signature
_____________________________________________________________________
*This portion shall be filed up by the DENR
Application No.: ____________________________
Before me, at the place aforesaid on this __________________ day of _____________, ______
personally appeared ____________________________ known to be person whose name
appears in the foregoing application, and in my presence signed the said application and
subscribed and sworn to this affidavit. He/she exhibited to me his/her Government Issued ID
No._____________________ issued at____________________________________ on
____________________.
____________________________
This form is not for sale
Officer Authorized to Administer Oath
Republic of the Philippines

Department of Environment and Natural Resources
Cordillera Administrative Region
Community Environment and Natural Resources Office-Buguias
Km. 21, Caliking, Atok, Benguet
e-mail Address: [email protected]
NOTICE OF APPLICATION FOR FREE PATENT
NOTICE IS HEREBY GIVEN that ROMULO ALUTANG has filed with this office an
Agricultural Free Patent Application under the provisions of CHAPTER VII of
Commonwealth Act 141, as amended and Republic Act No. 11573 to a tract of land
Situated in Barangay Sagubo, Municipality of Kapangan, Province of Benguet, Philippines,
described as follows:
Lot No.: ___________________________

Survey No.: ___________________________
Area: ___________________________
All adverse claims to the tract of land as described above must be filed in this
office within the posting period, otherwise, said application shall be given due course.
LEONORA S. GARCIA
OIC - CENR Officer
Date: _____________
Date of Posting:
From ________________________ to ___________________________

2022 Fpa App Form Blank

Uploaded by

Copyright:

Available Formats

2022 Fpa App Form Blank

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2022 Fpa App Form Blank

Uploaded by

Copyright:

Available Formats

Republic of the Philippines

Department of Environment and Natural Resources

APPLICATION FOR AGRICULTURAL FREE PATENT

Lot No. :_______________________ Location

1. I am not an owner of more than 12 hectares of land.

4. (Optional, if the applicant is a transferee)

The previous cultivator, _______________________________ who was my ancestor,

6. I am________________, the only heir/representative of the heirs of

Application No.: ____________________________

Republic of the Philippines

NOTICE OF APPLICATION FOR FREE PATENT

Lot No.: ___________________________

From to ___

You might also like