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REPUBLIC OF THE PHILIPPINES)

SORSOGON CITY ) S. S.

AFFIDAVIT OF LOSS

I, MARIO D. DUKA JR., of legal age, married, Filipino, and a resident of San Isidro, Bacon District,
Sorsogon City, Philippines, after being sworn in accordance with law, hereby depose and state;

1. That I am one of the heirs of Late MARIO DUKA SR. registered owner of a parcel of land located
at Barangay Sawanga, Bacon, Sorsogon, containing an area of One Thousand Three Hundred
Eighty Eight (1,388) Square Meters covered by Original Certificate of Title No. P-13769 of the
Registry of Deeds of Sorsogon City;

2. That when my father died, my mother and siblings entrusted to me the Owner’s Duplicate
copy of Original Certificate of Title P- 13769. They likewise delivered to me possession the
subject parcel of land and since then I have openly exercised and maintained all rights
of ownership thereon;

3. That we were not able to immediately effect transfer the title in our name because we were
then preoccupied with our jobs and family needs;

4. That during the onslaught of Typhoon Glenda sometime in 2014 a portion of our house was
destroyed by the said typhoon and I discovered that the original duplicate owner’s copy of Original
Certificate of Title No. P- 13769 was missing and could no longer find it in my files. 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;

5. That I certify and confirm that the parcel of land covered by Original Certificate of Title No. P-
13769 of the Registry of Deeds of Sorsogon was never mortgaged, sold, conveyed, disposed of, or
encumbered, to any other person or entity. I certify and confirm further that said document
was neither confiscated nor relinquished in favor of, any government entity agency, or authority.

6. 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 Affidavit of Loss in support of my application for
issuance of Second Owner’s duplicate copy of Original Certificate of Title No. P- 13769 as well
as for all lawful intents and purposes it may serve.

IN WITNESS WHEREOF, I set my hand this _____________at Sorsogon City, Philippines.

MARIO D. DUKA JR.


Affiant
DRIVERS LICENSE NO.E05-96-.14029

SUBSCRIBED AND SWORN to before me this _______________at Sorsogon City, Philippines.

Doc. No.
Page No.
Book No.
Series of 2017
July 06, 2017

To: The Register of Deeds


Sorsogon City

NOTICE OF LOSS

Sir:

Notice is hereby given that the owner’s copy of the Original Certificate of Title
P-13769 registered in the name of Late MARIO DUKA SR. has been discovered to be
lost and beyond recovery.

Truly yours,

MARIO D. DUKA JR.


VERIFICATION AND CERTIFICATION

REPUBLIC OF THE PHILIPPINES)


Province of Sorsogon ) S.S.
City of Sorsogon )

I, MARIO D. DUKA JR., of legal age, Filipino citizen, married, and with
residence and postal address at Brgy. San Isidro, Bacon, Sorsogon City,
Philippines, after having been duly sworn to in accordance with law, hereby
depose and say: That I am the Petitioner in the above-entitled case; That I
have caused the preparation of the above Petition and I have read the same
and know the contents thereof; That the allegations contained therein are true
and correct of my own personal knowledge.

That I further certify that: (a) I have not theretofore commenced any
other action or proceeding or filed any claim involving the same issues or
matter in any court tribunal or quasi-judicial agency and, to the best of my
knowledge, no such action or proceeding is pending herein; (b) If I should
therefore learn that the same or similar action or proceeding has filed or
pending the supreme court , the Court of Appeals, or any other tribunal or
quasi-judicial agency, I undertake to report such fact within five (5) days there
from to the court or agency wherein the original pleading and sworn
certification contemplated herein have been filed.

IN WITNESS WHEREOF, I have hereunto set my hand this


_______________, at Sorsogon City, Philippines.

MARIO D. DUKA JR.


Affiant
DRIVERS LICENSE NO. E05-96-.14029

SUBSCRIBED AND SWORN to before me this___________________at


Sorsogon City, Philippines.

Doc. No. ______;


Page No. ______;
Book No.______;
Series of 2017