Republic of the Philippines }

City of Davao }
x---------------------x

AFFIDAVIT OF LOSS
I, MARGOT GRACE U. GUILLERMO, Filipino, of legal age, single, and a resident of
Block 12, Lot 16, Phase 1, Nehemiah St. Emily Homes, Cabantian, Davao City, Philippines, after
being duly sworn in accordance with law, depose and state that:

1. I am the same and identical person who caused the execution of this instrument;

2. On 20 February 2019, I requested at the office of the Registry of Deeds – Davao

City, a certified true copy for a certain property with Transfer Certificate Title (TCT) No.
T-388088;

3. Thereafter, I was issued by the Registry of Deeds an Official Receipt to be

presented upon claiming the said certified true copy of the title;

4. I placed the said Official Receipt in my wallet for safekeeping;

5. As I was searching for the Official Receipt in my wallet, I could not find the
same;

6. I exerted diligent efforts to search for the said Official Receipt, but the same
could not be found and proved to have been lost;

7. The said Official Receipt was not confiscated by any government authorities or
agencies; and

8. I am executing this affidavit to attest to the truth and veracity of the foregoing
statements, for the claiming of property title at the Registry of Deeds, and to inform the
concerned government agency of the same facts.

MARGOT GRACE U. GUILLERMO

AFFIANT
Valid ID No. ___________________________

SUBSCRIBED AND SWORN to before me, this ___________________________, in the

City of Davao, affiant exhibiting before me as competent proof of her identity her
___________________________.

Doc. No. ______;

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