REPUBLIC OF THE PHILIPPINES )

MUNTINLUPA CITY ) S. S.
METRO MANILA )

AFFIDAVIT OF LOSS

I, ___________________________________, of legal age, Filipino citizen, married and

with residence and postal address at _____________________________________________,
after being duly sworn to in accordance with law hereby depose and say:

1. That I am a holder of Original Copy of Transfer Certificate of Title No.

_________________ of a certain parcel of land with improvement situated in the Bo.
of Poblacion, Municipality of Muntinlupa, Province of Rizal, containing an area of
_________________ (_________________) Square Meters, more or less duly
registered under the name of _________________;

2. That I use to keep the said land title in my files for convenience and safety purposes;

3. That on _________________, the said land title was already lost/missing and could
have been misplaced/left somewhere for unknown reason/s and I cannot find its
whereabouts;

4. That despite diligent effort to locate said land title all effort proved futile and the
same could no longer be found;

5. That I believe it is now beyond recovery;

6. That I am executing this affidavit to attest to the truth of the foregoing facts not
intended for any fraudulent purpose/s but to report the loss and for all legal intents
and purposes it may serve.

IN WITNESS WHEREOF, I am affixing my signature this ______________ at

Muntinlupa City, Philippines.

_____________________________

Affiant
_____ID No. ____________

SUBSCRIBED AND SWORN to before me in the date and place abovementioned.

Affiant exhibited to me his Competent Evidence of identity abovementioned.

NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 2020.