AFFIDAVIT OF LOSS

I, MINNIE BACORRO BAGAOISAN, of legal age, married, a dual citizen of

countries respectively known as, United States of America and the Philippines, with
postal address at 136 Kathy Ellen Ct., Vallejo California 94591, USA, after being sworn
in accordance with law, hereby depose and state that:

1. Me and my husband CELSO JACINTO BAGAOISAN are the purchasers / vendees

of a Parcel of Land together with the Improvements existing thereon, located at Dist.
of Novaliches, Quezon City, Island of Luzon. Containing an area of Two Hundred
Square (200) Meters more or less, covered by Transfer Certificate of Title No. T-35354 of
the Registry of Deeds of Quezon City.

2. Our above-mentioned purchase is evidenced by the Deed of Sale of a Registered Land and the
improvements thereon which was executed in our favor by JOSE MENDOZA BAUTISTA JR.,
and there upon acknowledged before Notary Public of the Consulate General of the
Republic of the Philippines, San Francisco. A copy of the said Deed of Sale of a
Registered Land and Improvements thereon is hereto attached and made an integral
part hereof as ANNEX “A”.

3. Immediately after the Deed of Sale of a Registered Land and Improvements thereon
was executed, the original duplicate owner’s copy of Transfer Certificate of Title No.
T-35354 was turned over to us by the late JOSE MENDOZA BAUTISTA JR. He
likewise delivered to us possession the subject parcel of land and its improvements and
since then we have openly exercised and maintained all rights of ownership thereon.

4. I was not able to immediately effect transfer the title in my name because I was then
residing outside of the Philippines with my husband. Sometime in _______, when I
decided to process the transfer of the title in our name, because I finally had the time and
opportunity to do so, I discovered that the original duplicate owner’s copy of Transfer
Certificate of Title No. T- 35354 was missing. I could no longer find it in my files. All diligent
efforts I exerted to locate and retrieve it were in vain; hence for all legal intents and
purposes it is now deemed lost and beyond recovery.

5. I certify and confirm that the parcel of land and its improvements covered by Transfer
Certificate of Title No. T-35354 of the Registry of Deeds of Quezon City 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 and based
on authentic documents or records. I am executing this Affidavit of Loss to support my application
for a new owner’s duplicate copy of Transfer Certificate of Title No. T-35354 as well
as for all lawful intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of

____________ 20___ at____________,________.

_______________________________
MINNIE BACORRO BAGAOISAN

SUBSCRIBED AND SWORN TO before me, a notary public in and for

_____________________ this ____ day of ____________ 20___. The affiant, whom
I identified through the following competent evidence of identity, to wit:

Passport Number __________________,valid from______ to______ issued

by_______________;
Driver’s License Number_____________, valid from______ to______ issued
by_______________,

personally signed the foregoing instrument before me and avowed under penalty of
law to the whole truth of the contents of said instrument.

Notary Public

Doc. No. ______;

Page No. ______;
Book No._____;
Series of 2018