NOTICE OF LOSS

THE REGISTER OF DEEDS

Zamboanga City

Sir/Ma’am:

Notice is hereby given the loss of Owner’s Duplicate Transfer of Certificate of

Title No. T-123,456, a parcel of land (Lot 9) of the consolidation subd. Plan, Pcs-09-
000811, being a portion of Lots 123 &1234-D (LRC) Psd-12345, situated in Mercedes,
City of Zamboanga, Island of Mindanao containing an area of FOUR HUNDRED
SEVENTY-SEVEN (477sqm). The said Owner’s Duplicate copy the Transfer Certificate
of Title was lost and efforts were exerted to locate it but the same cannot be found
and is believed lost beyond recovery.

I certify and confirm that the said document was never confiscated nor
relinquished in favor of, any government entity agency, or authority. 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 notice of loss to support my application for a new

Owner’s duplicate copy of Transfer Certificate of Title No. T-123,456 as well as for all
lawful intents and purposes it may serve.

INWITNESS WHEREOF, I set my hand this 13th day of August 2012, at

Zamboanga City, Philippines.

PEDRO A. SY
Affiant

SUBSCRIB ED AND SWORN to before me this 13 day of August,

2012 at Zamboanga City , affiant exhibited to me his
LTO Driver’s License with No. JO4-12-123456 for his identity.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2012.

Copy furnished:

MR. KRIS TAN

John St.,
Zamboanga City