Republic of the Philippines

REGIONAL TRIAL COURT

Branch _________
___th Judicial Region
_________City, Davao del _____, Philippines

IN THE MATTER OF THE PETITION LRC. CASE NO. _______

FOR ISSUANCE OF NEW OWNER’S
DUPLICATE COPY OF TRANSFER
CERTIFICATE OF TITLE NO. _________

_________,
Petitioner,

-versus-

THE REGISTER OF DEEDS FOR THE

PROVINCE OF DAVAO ___________,
Respondent.
X-------------------------------------------------------X

JUDICIAL-AFFIDAVIT OF IMELDA ORLANES

Show Proof: That the Owner’s Duplicate Copy of _________was lost

and the facts and circumstances thereto.
(Agi ug pagpamatuod sa pagkawala sa Owner’s Duplicate Copy sa
_________)

I, _________, of legal age, Filipino, married and a resident of

_________,Philippines, under oath and state that:
(Ako, si _________, sa hustong pang-edaron, Pilipino, minyu ug nagpuyo
sa _________, Philippines, karon nanumpa, ug naga-ingon nga:)

I was examined by Atty. _________in his office at _________,

Davao City, Philippines;

(Gi-pangutana ako ni Atty. _________, sa sulod sa iyang opisina sa Door 7

_________, Davao City, Philippines, sa sulod sa ingon nga opisina;)

I answered the questions the examining lawyer asked and I do so

under oath knowing fully that I may face criminal liability for false testimony
or perjury. The questions he asked me and my corresponding answers are
the following:
 (Akong gitubag ang mga pangutana sa nag-eksamina nga abogado ug ako
kining gibuhat samtang nanumpa, ug nakasabot ako nga pwede ako makasuhan ug
kasong kriminal kung ako mamakak. Ang iyang mga pangutana ug ang akong mga
tubag ay ania naka-sulat:)

1. Q: Please state for the record your name, address and

present occupation. (Palihug isulti imong pangalan ug kung
asa ka nagpuyo.)

A: Ako si _________, nagpuyo _________ug nanarbaho

isip _________.

2. Q: Do you know the Petitioner in this case?

(Nailhan ba nimo ang Petitioner aning maong kaso?)

A: Oo.

3. Q: If that’s the case, how are you related to the

Petitioner?
(Kung mao man, ig-unsa nimo ang Petitioner?)

A: Si _________ akong _________. Gihatagan ko niya ug

katungod nga mamahimong representative na moasikaso sa
Petition para sa pagkawala sa kopya sa iyang titulo tungod kay
sa iyang pangidaron, maglisud na siya.

4. Q: Do you have proof to establish such fact?

(Duna ba kay ebidensya agig pagpamatuod niini?)

A: Naa koy Special Power of Attorney.

5. Q: I am now marking this photocopied document

entitled SPECIAL POWER OF ATTORNEY as Exhibit “A”
and will attach it to your Judicial Affidavit to be an
integral part thereof. Do you confirm that this is the
same document you are referring to?
(Ako ning markahan ug Exhibit “A” ang photocopy sa maong
dokumento nga gi-nganlag SPECIAL POWER OF ATTORNEY aron
mamahimong lakip sa imong Judicial Affidavit)

A: Oo.
6. Q: What right, if any, does the Petitioner have over the
property embraced by Transfer Certificate of Title
_________ subject of this case?
(Unsay katungod, kung aduna man, naa ang Petitioner aning
yutaa nga dunay titulo _________?)

A: Siya ang tag-iya aning yutaa.

7. Q: Do you have proof to establish such fact?

(Duna ba kay ebidensya agig pagpamatuod niini?)

A: Naa koy kopya sa Transfer Certificate of Title

_________.

8. Q: I am now marking this photocopied document

entitled TRANSFER CERTIFICATE OF TITLE as Exhibit “B”
and will attach it to your Judicial Affidavit to be an
integral part thereof. Do you confirm that this is the
same document you are referring to?
(Ako ning markahan ug Exhibit “B” ang photocopy sa maong
dokumento nga gi-nganlag TRANSFER CERTIFICATE OF TITLE
aron mamahimong lakip sa imong Judicial Affidavit)

A: Oo.

9. Q: Where is the owner’s duplicate copy of Transfer

Certificate of Title No. _________?
(Asa ang owner’s duplicate copy sa titulo?)

A: Nawala ang kopya sa tag-iya.

10. Q: Was there any action upon realizing that the

owner’s duplicate Copy of Transfer Certificate of Title No.
_________was lost?
(Na ba moy gihimong aksyon pagkahibalo na nawala ang
owner’s duplicate copy sa titulo?)

A: Oo.

11. Q: Can you state to me how the owner’s duplicate

Copy of Transfer Certificate of Title No. _________was
lost?
 (Pwede ba nimo isaysay sa akoa kung naunsa pagkawala ang
maong kopya?)

A: Nalimot siya ug asa niya nabutang tungod sa iyang

pangidaron. Gitabangan nako sya ug pangita pero wala jud
nakaplagan ang kopya sa titulo. Nalimot sya ug asa jud niya
nabutang. Nagkuha akong igsuon ug Affidavit of Loss
pagpamatuod sa pagkawala, human niini ako mismo niadto sa
Registry of Deeds (ROD) para sa Notice of Loss/Memorandum
of Encumbrances.

12. Q: I am now marking these documents entitled Notice

of Loss dated _________as Exhibit “C” and Affidavit of
Loss dated _________ Exhibit “D” and will attach it to
your Judicial Affidavit to be an integral part thereof. Do
you confirm that this is the same document you are
referring to?
(Ako ning markahan ug Exhibit “C” ang kopya sa Notice of Loss
nga dunay petsa nga _________ug Exhibit “D” ang Affidavit
of Loss nga nabuhat ngadtong _________aron mamahimong
lakip sa imong Judicial Affidavit)

A: Oo.

13. Q: If you may recall, has the title been given to any
entity to for registration of mortgage or lease by reason
of sale or any form of conveyance pending for
registration with the office of the Registry of Deeds?
(Kutob sa imong madumduman, nahatag ba nimo ang titulo
kay bisag kinsa agig saad sa prenda, renta o baligya o aduna
bay nakapending na rehistro aning yutaa sa Registry of
Deeds?)

A: Wala gyud.

14. Q: What further actions were taken upon knowing that

the owner’s duplicate Copy of Transfer Certificate of Title
No. _________was lost?
(Unsa pa man lain ninyo gibuhat, kung aduna man,
pagkahibalo na Nawala ang kopya sa maong titulo?)

A: Nagkuha ko ug Certification sa Registry of Deeds

niadtong _________ nga nagcertify na adunay available na
 records sa TCT No. _________ug ang records nagpabiling
“INTACT”.

15. Q: I am now marking this document entitled

Certification dated _________as Exhibit “E” and will
attach it to your Judicial Affidavit to be an integral part
thereof. Do you confirm that this is the same document
you are referring to?
(Ako ning markahan ug Exhibit “E” ang kopya sa Certification
nga dunay petsa nga _________aron mamahimong lakip o
parte sa imong Judicial Affidavit)

A: Oo.

16. Q: Is the subject property embraced under Transfer

Certificate of Title No. _________declared for tax
purposes?
(Kining Titulo nga Transfer Ccertificate of Title No.
_________nadeklara ba para sa pagbayad sa buwis?)

A: Oo.

17. Q: Do you have any proof of that?

(Duna ba kay ebidensya agig pagpamatuod niini?)

A: Naa koy Tax Clearance ug Tax Declaration sa

_________nga nay TDN NO. _________.

18. Q: I am now marking these documents entitled Tax

Declaration bearing TD No. _________as Exhibit “F”
and Tax Clearance dated _________as Exhibit “F-1”
and will attach it to your Judicial Affidavit to be an
integral part thereof. Do you confirm that this is the
same document you are referring to?
(Ako ning markahan ug Exhibit “F” ang kopya sa Tax
Declaration nga nay TDN NO. _________, ug Exhibit “F-1”
ang kopya sa Tax Clearance nga dunay petsa nga
_________ug aron mamahimong lakip o parte sa imong
Judicial Affidavit)

A: Oo.
19. Q: Is there any pending litigation or land registration
proceedings involving the property embraced by
Transfer Certificate of Title No. _________?
(Wala ba nalambigit ning yutaa sa lain pang kaso batok sa
panag-iya aning yutaa?)

A: Wala ra ba.

20. Q: Do you have any proof of that?

(Duna ba kay ebidensya agig pagpamatuod niini?)

A: Nakakuha ko ug Certification sa Regional Trial Court

Branch _________sa _________ City nga nagpamatuod na
walay pending nga kaso or litigation bahin aning yutaa.

21. Q: I am now marking this document entitled Court

Clearance dated _________as Exhibit “G” and will
attach it to your Judicial Affidavit to be an integral part
thereof. Do you confirm that this is the same document
you are referring to?
(Ako ning markahan ug Exhibit “G” ang kopya sa Court
Clearance nga dunay petsa nga _________aron
mamahimong lakip o parte sa imong Judicial Affidavit. Uyon ka
ba niini?)

A: Oo.

22. Q: Do you have any existing farm worker or is the

property embraced by Transfer Certificate of Title No.
_________ under a leasehold agreement?
(Naa bay nagatikad aning yutaa o nalambigit ba kini sa
“leasehold agreement”?)

A: Wala.

23. Q: Do you have proof of that?

(Duna ba kay ebidensya agig pagpamatuod niini?)

A: Nagkuha ko ug Affidavit of Non-Tenancy niadtong

_________ agig pagpamatuod na walay tenants aning yutaa.

24. Q: I am now marking this document entitled Affidavit

of Non-Tenancy dated _________as Exhibit “H” and will
 attach it to your Judicial Affidavit to be an integral part
thereof. Do you confirm that this is the same document
you are referring to?
(Ako ning markahan ug Exhibit “H” ang kopya sa Affidavit of
Non-Tenancy nga dunay petsa nga _________ aron
mamahimong lakip o parte sa imong Judicial Affidavit)

A: Oo.

I also attest that the attachments in this Judicial Affidavit are faithful
reproductions of their corresponding original copies.

IN WITNESS WHEREOF, I hereby affix my signature this _____ day

of _______________ in ________________________, Philippines.

_________
Affiant
VIN: _________

SUBSCRIBED AND SWORN TO before me this _____ day of

____________ in ___________________, Philippines. The affiant-witness
_________, who exhibited to me a proof of her identity and for purposes of
proving that she voluntarily executed the foregoing instrument and fully
understood the contents thereof.

Witness my hand and seal.

Doc. No. ____ ;

Page No. ____;
Book No. ____;
Series of 2018.
 ATTESTATION

I, ATTY. _________, of legal age, Filipino, residing in Davao City,

Philippines with office address at _________, Davao City, Philippines, under
oath hereby states that:

1. I conducted and supervised the examination of _________, the

representative of the Petitioner in the above entitled case;

2. I faithfully caused to be recorded the questions I asked and the

corresponding answer that the representative of the Petitioner gave; and

3. Neither I nor any other person then present or assisting me coached the
representative of the Petitioner regarding her answers.

IN WITNESS WHEROF, I hereby affix my signature this ______ of

______________________ in ____________________, Philippines.

ATTY.

Attesting Lawyer

SUBSCRIBED AND SWORN TO before me this ______ day of

______________ in ____________________, Philippines. She presented to me
his __________________ bearing her photograph and signature as competent
evidence of her identity.

Witness my hand and seal.

Doc. No. ____ ;

Page No. ____;
Book No. ____;
Series of 2018.

Copy furnished:

REGISTRY OF DEEDS
_________
_________
_________ City

RR. No.: _______________

Date: _________________