REPUBLIC OF THE PHILIPPINES

PROVINCE OF PANGASINAN
)
CITY OF URDANETA
x------------------------------------------------x

)
SS.
)

AFFIDAVIT OF LOSS
I, LAURETA IGNACIO, widow, of legal age, Filipino, and resident of
Brgy. Anonas, Urdaneta City, Pangasinan, under oath, depose and say that:
1. I am the surviving spouse of the late Pablo C. Ignacio who died on 6

December 1999;
A copy of the Death Certificate is attached hereto as Annex A and
made an integral part of this Affidavit.
2. My late husband Pablo C. Ignacio and I own a property located in

Brgy. Domampot, Asingan, Pangasinan which was registered in our

name under TCT No. T-43220;
3. That I kept the owners duplicate copy of the said title in my cabinet

for safe keeping;

4. That several years later, when I went to locate said title as I planned

to transfer the same in the name of my children, I found out that it

was already missing and presumed lost;
5. That I exerted diligent efforts to recover and locate the same but to

no avail;
6. That said loss was neither due to the confiscation nor mortgaged to

any entities or whatsoever;

7. That I am executing this affidavit to attest to the truth of the

foregoing facts for all legal intents and purposes, in particular, to

request the Register of Deeds, Tayug, Pangasinan to issue another
Owners Duplicate copy of Transfer Certificate of Title No. T-43220 in
lieu of the lost one.
IN WITNESS HEREOF, I affixed my signature this 10 th day of March
2016 in Urdaneta City.
LAURETA ILDEFONSO
Affiant
Senior Citizens ID No.:
SUBSCRIBED AND SWORN to before me this 10 th day of March 2008
in Urdaneta City.

REPUBLIC OF THE PHILIPPINES

PROVINCE OF PANGASINAN
CITY OF URDANETA

)
SS.
)

AFFIDAVIT OF LOSS
I, AMELIA DELA CRUZ FERNANDO, married, of legal age, Filipino, and
resident of _________________________________, under oath, depose and say;
that:
8. I graduated at the Far Eastern University in 1980 with the degree of

Doctor of Medicine;
9. I was issued a college diploma in my maiden name AMELIA AGAPITO

DELA CRUZ;
10. Lately, I discovered that my said Diploma is missing and despite

diligent efforts exerted in order to recover and locate the same but
all to no avail;
11. Said loss was not due to the confiscation, or cancellation thereof, nor

was it given to any person or entity but is in fact loss;

12. I executing this affidavit to attest to the truth of the foregoing facts

and for the purpose of securing another Diploma in lieu of the lost
one.
IN WITNESS HEREOF, I affixed my signature this 2nd day of June, 2008
in Urdaneta City.

AMELIA DELA CRUZ FERNANDO

Affiant
PRC License No.: _____________
SUBSCRIBED AND SWORN to before me this 2 nd day of June, 2008 in
Urdaneta City.

REPUBLIC OF THE PHILIPPINES

PROVINCE OF PANGASINAN
CITY OF URDANETA

)
SS.
)

AFFIDAVIT OF LOSS
WE, CARLOS T. AGBANLOG, widower, CHARLTON M. AGBANLOG, CARLOS M.
AGBANLOG II, CHRISTIAN
M. AGBANLOG, CHARLOTTE M. AGBANLOG, all legal age, Filipinos, and residents
of Bactad East, Urdaneta City, under oath, depose and say; that:
13.We are the legal heirs of the deceased HELEN MANAOIS AGBANLOG who
passed away on 12 November 2006 in Bactad East, Urdaneta City;
14.HELEN MANAOIS AGBANLOG was a member of the Philippine Public School
Teachers Association (PPSTA) since _________________________and was
issued a Policy Contract;
15.When preparing all the requirements to claim all receivable benefits of the
deceased HELEN MANAOIS AGBANLOG with the PPSTA, we discovered that
said Policy Contract is no longer intact;
16.We exerted diligent efforts to recover and locate the same but all to no
avail;
17.Said loss was not due to the confiscation, mortgage, or cancellation thereof
or whatsoever;
18.We are executing this affidavit to attest to the truth of the foregoing facts
for all legal intents and purposes.
IN WITNESS HEREOF, we afied our signatures this 5 th day of May, 2008 in
Urdaneta City.

CARLOS T. AGBANLOG
Affiant
Drivers License No. _____________

CHARLTON M. AGBANLOG,
Affiant
TIN No. 940-251-226

CARLOS M. AGBANLOG II
Affiant
Drivers License No. ____________

CHRISTIAN M. AGBANLOG
Affiant
Drivers License No. ____________

CHARLOTTE M. AGBANLOG
Affiant
Postal ID No. ________________
SUBSCRIBED AND SWORN to before me this 5 th day of May, 2008 in
Urdaneta City.

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PANGASINAN
CITY OF URDANETA
)

)SS.

AFFIDAVIT OF LOSS
I, ESPERANZA R. BIAGTAN, of legal age, widow, Filipino, and a resident
of #7 Rizal Ave. Mangaldan, Pangasinan, after having been duly sworn
to in accordance with law, do hereby depose and say:
1.

That I am the surviving spouse of the late Hipolito Biagtan who

died sometime in the year 1975;

2.

That I own a property located in Brgy. Nibaliw, San Fabian,

Pangasinan which was registered in the name of my late husband
Hipolito Biagtan and the late Macario G. Ydia under TCT No.
98593;

3.

That the ownership was already consolidated in my name when

said Macario Ydia sold his undivided interest to me sometime in
the year 2004;

4.

That I kept the owners duplicate copy of the said title in my

cabinet for safe keeping;

5.

That several years later, when I went to locate said title as I

planned to transfer the same in the name of my son, I found out
that it was already missing and presumed lost;

6.

That I exerted diligent efforts to recover and locate the same

but to no avail;

7.

That said loss was neither due to

mortgaged to any entities or whatsoever;

8.

That I am executing this affidavit to attest to the truth of the

foregoing facts for all legal intents and purposes, in particular, to
request the Register of Deeds, Lingayen, Pangasinan to issue
another Owners Duplicate copy of Transfer Certificate of Title No.
98593 in lieu of the lost one, after payment of the necessary fees
therefor.

the

confiscation

nor

IN TESTIMONY WHEREOF, I have hereunto set my hand this 4 th day

of September 2008 at Urdaneta City.
ESPERANZA R. BIAGTAN
Affiant
SUBSCRIBED AND SWORN to before me this 4 th day of September
2008 at Urdaneta City.

DOMINICO A. SANCHEZ
Public Attorney II
Pursuant to RA 9406