Republic of the Philippines )

In the City of Muntinlupa ) S. S.

AFFIDAVIT OF LOSS
(Cancellation of Mortgage)
I, ___________________, of legal age, Filipino, widow, and with residence
address at ___________________________________________________, under oath,
hereby declare and state:

1. That, I am the widow of the late __________________, the

registered owner of a parcel of land with improvements thereon situated in
the _________________, containing an area of ______________________, and
covered by _______________________;

2. That, when my husband was still alive, he mortgaged the

aforesaid property with Urban Bank as evidenced by the annotation at the
back of the _________________ as _______________ in the amount of
________________________________;

3. That, before my husband died on September 06, 1997, he

already redeemed the said property by virtue of a Cancellation of Real
Estate Mortgage. Unfortunately, I was not able to get the said document
from my late husband before he died;

4. That, I exerted earnest efforts to possibly find the aforesaid

Cancellation of Real Estate Mortgage by looking for it in the personal
belongings of my late husband, but to no avail;

5. That, I am executing this affidavit to attest to the fact of loss of

the Cancellation of Real Estate Mortgage executed by ________________ in
favor of my late husband, ______________, and to satisfy the requirements of
the Registry of Deeds of _________________ to remove the aforesaid
annotation in the _____________________.

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

_____________________ in the City of Muntinlupa.

_______________________

SUBSCRIBED AND SWORN to before me in the City of Muntinlupa this

_____ day of ____________ by ___________________, who has satisfactorily
proven her identity to me through her _________________________, that she is
the same person who personally signed the foregoing affidavit of loss before
me and acknowledged that she executed the same.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2020.