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CARPER LAD Form No. 25
(Revised CARP-LAD Form No. 13)
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Region No._______________
Province of ______________
Municipality of ____________
REQUEST FOR CERTIFICATION OF RETENTION
__________________
Date
The Provincial Agrarian Reform Officer II
_________________________________
Sir/Madam:
May I request for the issuance of a Certification of Retention for my landholding pursuant to Republic Act (R.A.)
No. 6657, as amended by R.A. No. 9700, with a total of ___________ hectares and covered by the following:
TCT/OCT No.
TD No.
Lot No.
Approved Survey No.
Location
(Municipality, Barangay)
:
:
:
:
:
:
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
I certify under oath my total/aggregate ownership of agricultural land nationwide is ______ has. and I have not
sold or disposed of any agricultural Landholdings after June 15, 1988. This disclosure shall bind me to place under
CARP my excess agricultural lands.
Very truly yours,
___________________________________
(Signature over Printed Name of Landowner)
SUBSCRIBED and SWORN to before me, A Notary Public, this _____ day of
________________________, 20__, at ___________________________________, the above-named landowner
presented to me his/her Identification No. ___________ issued by _______________, valid until
______________, and he/she personally attested to me that the statements contained in herein are all true and
factual.
__________________________________
Notary Public
Doc. No.
Page No.
Book No.
Series of
_____
_____
_____
_____
Copy Distribution:
Original
Duplicate
Triplicate
-
DARPO
Landowner
DARMO