REPUBLIC OF THE PHILIPPINES)

TARLAC PROVINCE ) S.S.

AFFIDAVIT OF LOSS
I, REYNALDO P. ESGUERRA, of legal age, married to Virginia S. Lulu, Filipino, and a resident
of Brgy. Culipat, Tarlac City, Tarlac, after having been sworn to in accordance with law hereby
depose and say that:

1. I am the absolute and registered owner of the parcel of land, located at Brgy. Culipat,
Tarlac City, Tarlac, containing an area of 4,102 square meters, more or less, and covered
by TCT No. 20442.

2. However, by quite accident,the CERTIFICATE OF FULL PAYMENT AND RELEASE OF REAL

ESTATE MORTGAGE, issued by the LBP, was lost/missing, and despite diligent efforts to
locate the same our efforts proved futile and in vain;

3. All efforts were exerted to locate the aforementioned document but the same could not
found and is now considered as lost.

4. I have not see nor found the said documents, as of the date of execution of this
affidavit, and I do not expect to recover the same; and

5. As such, I am executing this affidavit to attest to the truthfulness of the foregoing

information, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of ___________
in ______________, Philippines.

REYNALDO P. ESGUERRA
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of _________ in ____________,

Philippines.

Doc. No____;
Page No. ___;
Book No. ___;
Series of ____.