AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES

PROVINCE OF _________________ SS
MUNICIPALITY OF _____________

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

married, residing at ______________________________________________ , after being
sworn in accordance with law, depose and say that:

1. I am the owner of a parcel of land located at ______________________,

containing an area of ________________, covered by Transfer Certificate
of Title _______________;

2. Aforementioned title is in my custody. However, when our old house

was about to be demolished on ____________ for the purpose of
renovation, I placed said title in a box along with some of my
important documents in a box;

3. Sometime in ____________, I discovered that the box containing the

Transfer Certificate of Title, and other pertinent documents were lost
when we moved back in. It might have been included in the items that
have been thrown out;

4. All diligent efforts were exerted and all possible means were made in
order to locate it. The title is now beyond recovery;

5. I certify and confirm that the parcel of land covered by Transfer

Certificate of Title No. _______ was never mortgaged, sold, conveyed,
disposed of, or encumbered, to any other person or entity. I certify and
confirm further that said document was neither confiscated nor
relinquished in favor of, any government entity agency, or authority;

6. I attest to the truth of the foregoing statements to the best of my own personal
knowledge. I am executing this Affidavit of Loss to support my application for a
new owner’s duplicate copy of Transfer Certificate of Title No.
__________ as well as for all lawful intents and purposes it may serve.
 IN WITNESS WHEREOF, I have hereunto set my hand this _____day of
_______________________ , 20 ____, in the Municipality of ___________, Province of
_______________ , Philippines.

_______________________
(Signature of affiant)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________ 20___.
Affiant personally came and appeared with _____________(Competent
Evidence of Identity)______ issued by the _________(Government Agency)______
on ___(date)__ at ________(place)_________, bearing his photograph and
signature, known to me as the same person who personally signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of
the contents of said instrument.

ATTY _________________________________
Doc. No. COMMISSION NO. _____________________
Page No. NOTARY PUBLIC for _____________________
Book No.
Series of 2019