Republic of the Philippines )

City of Iloilo ) S.S.

x--------------------------------x

AFFIDAVIT OF LOSS

I, EUFEMIA C. GONZALES, represented by my attorney-in-fact, SUSANA A.

CALERO (the copy of Special Power of Attorney is hereby attached), of legal age, Filipino,
widow and resident of Aglibacao, Calinog, Iloilo, after having been sworn to in accordance
with law, hereby depose and state:

1. That I am the purchaser of the delinquent real property owned by Philippine

Veterans Bank known as Lot No. 6345-C(LRC) (PSD-177478) covered by
Transfer Certificate of Title No. T-174169 containing an area of Eighteen
Thousand Four Hundred Fifty-Five (18,455) square meters and located at Brgy.
Aglibacao, Calinog, Iloilo. Attached hereto as ANNEX “A” is the Final Deed to
Purchaser issued by the Office of the Provincial Treasurer, Province of Iloilo
and made an integral part of this Affidavit;

2. That the owner’s duplicate copy of transfer certificate of title of the said
property was turned-over to me;

3. That I was not able to immediately effect to transfer the title in my name
because of the fact that I am residing in Metro Manila. However, when I
decided to process the transfer the title in my name, I discovered that the said
Owner’s duplicate copy of TCT No. T-174169 was missing and I could no longer
find it in my files.

4. That despite exerting earnest and diligent efforts to locate said title, the same
is believed to be lost and could no longer be found and believed to be beyond
recovery;

5. 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 to support my application for a new owner’s duplicate copy of
Transfer Certificate of Title No. T-174169 as well as for all lawful intents and
purposes it may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of

_______ 2019 at Iloilo City, Philippines.
 EUFEMIA C. GONZALES
Affiant

SUSANA A. CALERO
Attorney-in-Fact

SUBSCRIBED AND SWORN to before me this _____ day of ___________ 2019

at Iloilo City, Philippines, affiant personally appeared with his competent evidence of
identity which is: _____________________________________________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.