Republic of the Philippines )

City of ________________________ ) S.S.

AFFIDAVIT OF LOSS

I, ____________________, of legal age, Filipino, with office address at _________________________________,

after having been sworn to in accordance with the law hereby depose and state that:

1. I am the ___________________________________ (the “Company”) with business address at

_______________________________________;

2. Part of my duties is to pull-out, process and execute retitling of the original owner’s
copy of Transfer of Certificates of Title (TCT) of properties owned by the Company
that have already been purchased by the buyer;

3. On _____________________, I discovered that the owner’s duplicate copy of

_______________________________ which covers the parcel of land located in
__________________________________________ could not be located in the Company’s office;

4. After earnest effort to look for the owner’s duplicate copy of ________________________ on
all possible places which titles may be stored or filed, the said title still could not be
located;

5. In view of the foregoing, I am executing this affidavit to attest to the truth and veracity
of the previous statements and for the purpose of requesting the annotation of the
loss of the original owner’s copy of _______________________________, and for other legal
purpose this affidavit may serve.

AFFIANT STATES NOTHING FURTHER.

________________________________
Affiant

SUBSCRIBED AND SWORN TO before me Notary Public for and in the City of Makati, affiant
personally known to me and exhibiting her valid ___________________________ issued by the
______________________________ and attesting that the document is her true act and deed.

Doc No. ________;

Page No. _______;
Book No. _______;
Series of 2017.