__________________________
Date Name
of Children Age Actual Area
Tilling/Managing 1) 2) 3)
Very truly yours,
_________________________
The
Regional Director
Department of Agrarian Reform
_____________________________
_____________________________
Thru: The MARO
____________________________
____________________________
I have the honor to apply for the retention of ______________ ( ) hectares,
more or less, pursuant to Section 6 of RA 6657.
 
The landholding which I chose to retain is a portion of my landholding with
a total area of _____________________ ( ) hectares, more or less, covered
by OCT/TCT/TD Nos. _______________________ registered inmy name by the Register
of Deeds and the Municipal/Provincial Assessor’s Office of ______________________
and ___________________________ respectively.
 
For and in behalf of my qualified children, I further apply for the awarding
of the three (3) hectares out of my subject landholdings they are
Landowner
Name and Signature