Republic of the Philippines )

_________________________) S.S.
x--------------------------x

AFFIDAVIT OF DESTRUCTION/MUTILATION

I, __________________, of legal age, single, Filipino citizen, and presently residing at

Brgy. ________________, Talavera, Nueva Ecija, after having been duly sworn to in accordance
with law, do hereby depose and say:

1. That I bought the house and lot of _______________ (the Seller) married to ____________,
located at San Ricardo, Talavera, Nueva Ecija under TCT No. E.P. No. ____________ as
evidenced by the Deed of Sale;
2. That the Owner’s Duplicate Copy was already given to me by the Seller;
3. That I have already paid the required Capital Gains Tax to the Bureau of Internal Revenue in
Talavera, Nueva Ecija and was issued a Certificate Authorizing Registration;
4. That I already paid the required Transfer Tax at the Treasurer’s Office of Nueva Ecija in
Palayan City and was issued a Clearance;
5. That on 8 April 2018 as I prepare for the registration and transfer of the property under my
name, I discovered that the following documents (copies attached) were damaged by
termites, namely:

a. Deed of Sale;
b. TCT No. E.P. No. ______________;
c. Tax Declaration;
d. Certification Authorizing Registration; and
e. Transfer Tax Clearance

6. That the destruction of the abovementioned documents have rendered it unusable for the
registration and transfer of the property under my name; and
7. That I attest to the veracity of the foregoing information.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of April 2018 at
______________, Philippines.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ______ 2018 in _________,
Philippines, affiant exhibiting to me his/her competent evidence of identity by way of
_______________ issued at ___________ on ________________.

Doc No. : _____

Page No.: ______
Book No.: ______
Series of 2014 Notary Public