Republic of the Philippines )

Province of XXX ) S. S.

AFFIDAVIT TO RECOVERY OF LOST TITLE

I, XXX, Filipino, single, __ years old, a resident of Barangay

XXX, after having been duly sworn to in accordance with law, do
hereby declare that:

1. I am the registered owner of a parcel of land situated in

Barangay xxx contained in TCT No. xxx, more particularly
described as follows:

XXX ”

2. I executed an Affidavit of Loss in relation to TCT No. xxx

on 27 March 2017 before the Atty. xxx, Notary Public, with
Doc. No. xxx, Page No. xxx, Book No. xxx, Series of
2017;

3. Said Affidavit of Loss was annotated in the record of the

said title in the Registry of Deeds (RD) for the Province of
xxx under Entry No. xxx dated xxx;

4. A concerned person surrender to herein Affiant her lost

copy of the original title;

5. I hereby certify that the statements made herein are true

and correct to the best of my knowledge and belief.

6. I executed this Affidavit to attest to the truthfulness of the

contents of this document and for the purpose of
requesting the Office of the RD for the Province of xxx to
annotate this Affidavit.

IN WITNESS WHEREOF, I have hereunto set my hand this xxx

in xxx.
xxx
Affiant

SUBSCRIBED AND SWORN to before me this xxx in Bulacan,

Philippines, affiant exhibiting her ID with number __________ issued
by _______________ on __________. I certify that I personally
examined the affiant and that she voluntarily executed the foregoing
affidavit and understood the contents thereof.
Notary Public,
Doc. No.: _____
Page No.: _____
Book No.: _____
Series of 2018.