REPUBLIC OF THE PHILIPPINES | S. S.

TACLOBAN CITY, LEYTE |

AFFIDAVIT OF LOSS

I, CARLO C. BUTIG, of legal age, singe, Filipino, visually impaired and a resident of Brgy.
71 Kristina Heights Subv, Naga-Naga, Tacloban City, Leyte, Philippines, after being sworn in
accordance with law, hereby depose and state—

1. I am the owner of a parcel of land located at Barangay 81, Tacloban City containing
an area of One Hundred Square Meters covered by Transfer Certificate of Title No. T-15784 of
the Registry of Deeds of Tacloban City.

2. Sometime on June 2020, when I decided to process the transfer of the title in the
name my oldest brother Carl Metoy Butig as donation, I discovered that the original duplicate
owner’s copy of Transfer Certificate of Title No. T-15784 was missing in the vault where I put
it. I could no longer find it in owner’s copy of Transfer Certificate of Title. 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.

4. I certify and confirm that the parcel of land covered by Transfer Certificate of
Title No. T-15784 of the Registry of Deeds of Tacloban 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.

5. 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-15784 as well as for all lawful intents and purposes it may serve.

IN WITNESS WHEREOF, I set my hand this 26th day of July 2021 at Tacloban City,
Philippines.

CARLO C. BUTIG
Affiant
Senior Citizen ID No. 05072

SUBSCRIBED AND SWORN TO before me, a notary public in and for Tacloban City this
26th day of July. The affiant, whom I identified through the following competent evidence of
identity: Senior Citizen ID No: 05072, issued by Office of the Senior Citizen Affairs(OSCA),
personally signed the foregoing instrument before me and vowed under penalty of law to the
whole truth of the contents of said instrument.

ATTY. CARLITO C. HILVANO

Notary Public
Until December 31, 2023
N. A. No. 31-EV-12-R
Attorney’s Roll No. 9191
IBP No. 201932 02.24.2021 Manila City
PTR No. 1234567 01.02.2021 Manila City
Doc. No. 1 MCLE Compliance No. XI-0001000; 08.05.2019
Page No. 1
Book No. 2
Series of 2021