Republic of the Philippines]

Tuguegarao City, Cagayan ]S.S

AFFIDAVIT OF LOSS

I, ___________, of age, married, Filipino and resident of

_______________, after having sworn to in accordance with law,
hereby depose and state, that:

1. My deceased mother, _____________, is the registered

owner of a parcel of land located at Barrio of
_____________ and covered by Katibayan ng Orihinal na
Titulo Blg. ___________ particularly described as follows:

“xx”

2. The owner’s duplicate copy of Katibayan ng Orihinal na

Titulo Blg. _______ was entrusted to me by my mother,
_______, for safekeeping, and I placed it in my cabinet;

3. Long after the death of my mother, my siblings and I

decided to subdivide the lot, as such, they were asking
for the owner’s duplicate copy of Katibayan ng Orihinal
na Titulo Blg. ___________;

4. Upon checking and searched in my cabinet and also in

other cabinets in my house for the owner’s duplicate
copy of Katibayan ng Orihinal na Titulo Blg. ____________

5. Further the Owner’s Duplicate Copy of Katibayan ng

Orihinal na Titulo Blg. ______________ that was lost was
never mortgaged nor given to any person or entity for the
satisfaction of any obligation whatsoever;

6. I am executing this Affidavit to inform the REGISTRY OF

DEEDS of Cagayan as to the fact loss of the said Owner’s
Duplicate Copy of Katibayan ng Orihinal na Titulo Blg. P-
___________, and to request the annotation of this
Affidavit of Loss on the copy of Katibayan ng Orihinal na
Titulo Bilang _____________ that is on file with the
Registry of Deeds of Cagayan.
 7. I am executing this affidavit to attest to the truthfulness
of the statements that is narrated above.

IN WITNESS WHEREOF, I have hereunto set my hand this

________________, at Tuguegarao City, Cagayan.

______________
Affiant

SUBSCRIBED AND SWORN to before me, this

_____________ at Tuguegarao City, Province of Cagayan, affiant
___________ exhibited to me a Senior Citizen Identification No.
_________________ showing her picture and signature.

Doc. No.____________;
Page No.____________;
Book No.____________;
Series of 2024.