Republic of the Philippines

REGIONAL TRIAL COURT OF BOHOL

7th Judicial Region
Branch 2 Tagbilaran City

IN RE: PETITION FOR THE ISSUANCE OF

SECOND OWNER’S DUPLICATE COPY OF
TCT NO. (1234567
SP PRO NO. 9999

aaaaaaaaaaaaaaaaaaaaaaaREP.BY:
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Petitioner
JUDICIAL AFFIDAVIT

Question No.1: Please state your name and other personal circumstances.

Answer: I am Engr. zzzzzzzzzzzzzzzzzzzzzzzz, Filipino, of legal age, and

with an office address at Land Registration Authority (City Registry of Deed,
DDDDDDDDDDDDDDDDDDDDDDDD

Question No.2: What is your position/rank in the City Register of Deeds;

Answer: I am a Land Registration Examiner I, of the City Registry of Deeds;

Question No.3: As LEA I, did you bring with you the physical original copy from
your office of TCT No.1234567

Answer: Yes, I have with me the original copy of TCT No. 123457

Question No.4: Is the title that you are bringing today, is the same title which is
subject of this petition, and marked as Exhibit “C” of the Judicial Affidavit of
uuuuuuuuuuuuuuuuuuuuuuuuuu, the petitioner’s representative;

Answer: Yes, it is the same lot which is the subject of this petition;

Question No.5: Are there any annotations at the back of the said original title of TCT
No. 1234567

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 Answer: Yes, there are annotations. In fact, there is an Affidavit of Loss
recorded in our system, and was executed by a certain PPPPPPPPPPPPPPPPP on
June 19, 2014;

Question No.6: Are there any annotations of encumbrance/s, lis pendens, adverse
claim or mortgage of the said title?

Answer: None. The title is free from any claims.

Question No.7: Do you affirm and confirm the truth and veracity of the
statements contained in this Judicial Affidavit?

Answer: Yes. I affirm them as true and correct to the best of my personal
knowledge.

Question No. 8: Please state the name of the lawyer who examined you and the
place of examination?

Answer: I was examined on the date indicated in this judicial affidavit by

Atty. CCCCCCCCCCCCCCCCCCCCCCCCCC at her address at Bujol, Bohol’

Question No. 9: Are you aware that you are under oath which means that any
falsehood that you state in your affidavit may subject you to a criminal liability for
false testimony or perjury?

Answer: Yes. I am fully aware of that.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this 2 nd

day of October, 2023 at Tagbilaran City, Bohol.

FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
Affiant

SUBSCRIBED AND SWORN TO before me on this _____th day of October,

2023 in Bujol, Bohol. Affiant exhibited to me his _____________ which is valid until
_______________.

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 SWORN ATTESTATION

I, TTTTTTTTTTTTTTTTTTTTTTTTTTTTFilipino, of legal age, married and

with address in Tagbilaran City, under oath depose and say:

1. I am the lawyer who conducted the examination of witness,

OOOOOOOOOOOOOOOOOOOOOOOOin my office in Tagbilaran City on October
2, 2023;

2. I hereby attest that I faithfully recorded or caused to be recorded the

questions I asked and the corresponding answers that the witness gave;

3. I did not or any other person then present, coach the witness regarding
the latter’s answers.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this

_____th day of F in Tagbilaran City, Bohol.

TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT
Affiant

SUBSCRIBED AND SWORN to before me on this ______ day of October, 2023

in Tagbilaran City. Affiant exhibited to me her Local I.D No. 00095.

Doc. No. ___ __:

Page No. _____:
Book No. ____:
Series of ______.