Republic of the 

Philippines)
City of Cabanatuan         ) s.s.

AFFIDAVIT OF LOSS

I, RENE SMITH, of legal age, Filipino, and a resident of Brgy. Liberty,

Pantabangan, Nueva Ecija, after having been duly sworn to in accordance with
law, hereby deposes and states :

1. That I am the registered owner of a parcel of land situated at Brgy. Bakod Bayan,
Cabanatuan City, Nueva Ecija covered by Transfer Certificate of Title No.
XXXXXX-XXXXXXXXXXX with an area of Eighteen Thousand Five Hundred
Nineteen (18, 519) square meters;

2. That the said title is in my possession since the time of its issuance and was kept
in an envelope placed inside a cabinet in my residence together with other
important belongings;

3. That sometime on October 2015, I noticed that the envelope containing the
certificates of title was already missing from my files and personal belongings;

4. I believe it was lost due to the flood that we experienced prior to my discovery of
the loss of the said title;

5. That said certificate of title is nowhere to be found and despite exerting diligent
efforts to locate it, everything proved futile;

6. That in order to protect my interest over the said certificate of title, I have
executed this affidavit for the purpose of registration with the Register of Deeds of
Nueva Ecija and in order to file a petition for issuance of second owner’s copy of
Transfer Certificate of Title No. XXXXX in court;

7. That I am executing this affidavit to attest to all the above facts and to request the
Honorable Register of Deeds of Nueva Ecija to annotate at the back of the original
copy of Transfer Certificate of Title No. XXXXX the fact of loss of the owner’s copy
of the said certificate of title;

 IN WITNESS WHEREOF, I have hereunto set my hand this __________________ in

Cabanatuan City, Nueva Ecija, Philippines.

RENE SMITH
Affiant

SUBSCRIBED AND SWORN to before me, this ________________ at

Cabanatuan City, Nueva Ecija. The affiant has exhibited to me his competent
evidence of identity as provided under Supreme Court A.M. No. 02-8-13-SC.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2020.