REPUBLIC OF THE PHILIPPINES | S. S.

CITY OF BAGUIO |

AFFIDAVIT OF LOSS
(Lost Title)
I, _______________, of legal age, single, Filipino, and a resident of Km. 5, La Trinidad,
Benguet, Philippines, after being sworn in accordance with law, hereby deposes and states that—

1. I am the purchaser / vendee of that parcel of land located at ____________ of Two Hundred
Square Meters covered by Transfer Certificate of Title No. of the Registry of Deeds of Benguet—as
evidenced by the Deed of Sale of a Registered Land which was executed in my favor by and
thereupon acknowledged before Notary Public and docketed in his Notarial Registry as “Doc. No.
427; Page No. 87; Book No. 12; and Series of 2007.” A copy of the said Deed of Sale of a Registered
Land is hereto attached and made an integral part hereof as ANNEX A.

2. Immediately after the Deed of Sale of a Registered Land was executed, the original duplicate owner’s
copy of Transfer Certificate of Title No. T-63274 was turned over to me by ________________;

3. He likewise delivered to me possession the subject parcel of land and since then I have openly exercised
and maintained all rights of ownership thereon.

4. I was not able to immediately effect transfer the title in my name because I was then preoccupied with my
studies at Aviator Flight School in Cebu City and at Clark Aviation School in Clark Freeport, Pampanga.

5. Sometime in April 2012, when I decided to process the transfer of the title in my name, because I finally
had the time and opportunity to do so, I discovered that the original duplicate owner’s copy of Transfer
Certificate of Title No._____________ was missing and I could no longer find it in my
files.

6. 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.

7. I certify and confirm that the parcel of land covered by Transfer Certificate of Title No._____
of the Registry of Deeds of Benguet was never mortgaged, sold, conveyed, disposed of, or encumbered,
to any other person or entity.

8. I further certify and confirm further that said document was neither confiscated nor relinquished in favor
of, any government entity agency, or authority.

9. I attest to the truth of the foregoing statements to the best of my own personal knowledge and based on
authentic documents or records.

10. I am executing this Affidavit of Loss to support my application for a new owner’s duplicate copy of
Transfer Certificate of Title No.__________ as well as for all lawful intents and purposes it may serve.

IN WITNESS WHEREOF, I set my hand this 2nd day of July 2012 at Baguio City, Philippines.

_______________________________

Affiant
Driver’s License No.
Firearm License No.

SUBSCRIBED AND SWORN to before me this 2nd day of July 2012 at

Baguio City Philippines.
1
 ATTY. OSCAR A. CORPUZ, JR.
Notary Public
Until December 31, 2013
Doc. No. 189 N. A. No. 54-NC-12-R
Page No. 38 Attorney’s Roll No. 53486
Book No. III IBP No. 863438 01.02.2012 Baguio City
Series of 2012 PTR No. 0793799 01.02.2012 Baguio City
MCLE Compliance No. IV-0000200; 08.04.2010