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Republic of the Philippines

)
_____________________)S.S.

AFFIDAVIT OF LOSS
I, CATALINA Y. CANO, of legal age, Filipino citizen, single and with residence
address at #0040 Vergel De Dios St., Concepcion, Baliuag, Bulacan, after having been
duly sworn to in accordance with law do hereby depose and say:

1.I am the lawful owner of that parcel of land situated in Concepcion, Baliuag,
Bulacan consisting of Three Hundred Fifty Nine (359) square meters as evidenced by
and more particularly described in Transfer Certificate of Title No. T-123891 of the
Registry of Deeds for the Province of Bulacan;

2.Being the lawful owner thereof, I was issued the corresponding owner’s
duplicate of the said Transfer Certificate of Title No.T-123891 by the Office of the
Registry of Deeds for the Province of Bulacan;

3.That the owner’s duplicate of the said Transfer Certificate of Title No. T-
123891 is considered as lost after the same was placed in the custody of my nephew
Romeo C. Gaitmaitan who is now living abroad, and claiming that he cannot locate
anymore the wherabout of the said Owner’s Duplicate of the said Transfer
Certificate of Title No. T-123891;

4.That despite diligent efforts exerted by me to locate the said Owner’s
Duplicate of the Transfer Certificate of Title No. T-123891, the same cannot be
located anymore and is now considered as lost;

5. I executed this Affidavit of Loss to attest to the truth of the foregoing facts
and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of
May 2017 in _____________________.

CATALINA Y. CANO
-Affiant-

SUBSCRIBED AND SWORN to before me this _____ day of May 2017 in
_____________________, affiant exhibited to me her Senior Citizens I.D. No. 9638
issued by the Office of the Senior Citizen Affairs, Municipality of Baliuag, Bulacan on 9-
11-2014

NOTARY PUBLIC
Doc No. _______;
Page No. ______;
Book No. ______;
Series of 2017.