REPUBLIC OF THE PHILIPPINES)

Quezon City) S.S.

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

AFFIDAVIT OF LOSS

I, I, GENARO GAERLAN LOPEZ, of legal age, Filipino citizen and a

resident of 56 Matahimik St. Teacher’s Village, Quezon Cit after being duly sworn
in accordance with law, depose and state:

1. That I am the son of one of the registered owners, the late Luz Gaerlan
Lopez, of a lot covered by Transfer Certificate of Title No. 55350 which was
in my possession as it was entrusted to me by my mother;

2. That sometime on November 2019, I discovered that the said owner’s copy of
said title was missing from my files;

2. That despite diligent search and efforts to locate the said owner’s copy of
Transfer Certificate of Title No. 55350, I could not find the same such that I
now believe that they are now lost beyond recovery.

3. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

Orion, Bataan, Philippines.

GENARO GAERLAN LOPEZ

Affiant

SUBSCRIBED AND SWORN to before me, this _______________, by the Affiant

who presented to me his ___________________________ as his competent evidence of
identity.

NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No.______;
Series of 2020.