JOINT AFFIDAVIT OF LOSS

I, xxxxx, of legal age, Filipino, single and a resident of Bacolod City, Negros
Occidental, Western Visayas, under oath, depose and say that:

<1> I am the registered co-owner of a parcel of land located at the Barangay of

Cansilayan, Municipality of Murcia, Negros Occidental, Western Visayas. As evidenced by
Transfer Certificate of Title No. 0000000003 issued by the Register of Deeds for the
Province of Negros Occidental, containing an area of Forty Six Thousand Five Hundred
Ninety Four square meters (46594), more or less, more particularly described as:

TRANSFER CERTIFICATE OF TITLE NO. 00000000

“TECHNICAL DESCRIPTION

AREA: FORTY SIX THOUSAND FIVE HUNDRED NINETY FOUR SQUARE METERS
(46594), MORE OR LESS”

<2> I am the custodian of Owner’s Duplicate Copy of TCT No. 0000000. I searched
for the Owner’s Duplicate Copy of TCT No. 0000000 among my personal files at home,
where I usually kept my records, and wherever I could have placed it but the same could
not be found;

<3> I do not recall giving the Owner’s Duplicate Copy of TCT No. 000000 to any
person or entity for any reason whatsoever. Neither has it been forfeited nor cancelled;

<5> In view of the foregoing, I am constrained to declare that the Owner’s

Duplicate Copy of TCT No. 0000000 issued to me by the Register of Deeds for the Province
of Negros Occidental is lost for all legal intents and purposes;

<6> This AFFIDAVIT OF LOSS is being executed to attest to the truth of the
matters herein stated.

SIGNED this _____________in the City of Bacolod, Philippines.

xxxx
Affiant
Republic of the Philippines)
CITY OF BACOLOD )S.S.
x - - - - - - - - - - - - - - - - - - - -x

SUBSCRIBED AND SWORN to before me this _________________ in the City of Bacolod,

Negros Occidental, Philippines. AFFIANT exhibited to me competent evidence of identity
written below her name.

Doc. No. ______;

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