Republic of the Philippines )

City of Iloilo ) S.S.

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

AFFIDAVIT OF LOSS

I, MARIVIC PATOSA PENUELA, of legal age, Filipino, married to HENRY

PENUELA, and resident of Brgy. Malusgod, Pototan, Iloilo, after having been sworn to
in accordance with law, hereby depose and state:

1. I am a holder of Two (2) Transfer Certificates of Title of Real Property located

at Bo. of Batuan, Pototan, Iloilo. Here are the following TCTs:

A. TCT No. 090-2012003782: Lot No. 7581-A-7 PSD-006773

containing an area of THREE HUNDRED AND TWENTY-TWO
square meters (322sq.m.);

B. TCT No. T-121398: Lot No. 7581-A-10 containing an area of TWO

THOUSAND SEVEN HUNDRED EIGHTY-FIVE square meters
(2785 sq.m.);

2. That I am the owner of the first lot covered by TCT No. 090-2012003782,
and the second lot covered by TCT No. T-121398 is registered under the
name of my father, VICTORINO PATOSA.

3. That I have in my possession the Owner’s Duplicate copies of the above-

mentioned Transfer Certificates of Title;

4. That sometime in August 2019, I discovered that last pages of the said
Owner’s Duplicate copy of the said Transfer Certificates of Tile consisting of 3
pages each were missing. I tried to locate the said missing pages of Owner’s
Duplicate Copy of TCT No. 090-2012003782 and TCT No. T-121398, but to
no avail.

5. That despite exerting earnest and diligent efforts to locate said missing pages
of the said titles, the same is believed to be lost and could no longer be found
and believed to be beyond recovery;

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 to support my application for a new owner’s
duplicate copy of Transfer Certificate of Title No. T-090-2012003782 and T-
121398 as well as for all lawful intents and purposes it may serve;
 IN WITNESS WHEREOF, I have hereunto set my hand this 14 th day of August
2019 at Iloilo City, Philippines.

MARIVIC PATOSA PENUELA

Affiant

SUBSCRIBED AND SWORN to before me this 14th day of August 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.