REPUBLIC OF THE PHILIPPINES)

CITY OF DAVAO - - - - - - - - - - - )S.S

X-----------------------X

AFFIDAVIT OF LOSS

I, CHANYEOL PARK, of legal age, Filipino, and a resident of Davao City, Philippines, after being
duly sworn to in accordance with the law depose and say:

That I am the one who entry all the documents to the Registry of Deeds with EPEB NO. 496-
00000011111 DATED August 27, 2020 and the transaction type is a Registered Land;

That sometime in the month of October 2020 when I follow-up later, the Original Receipt was lost
and despite diligent effort exerted, to no avail, and because of that I am informing the registry of deeds
authorities concerned.

That this affidavit is executed in order to appraise the authorities concerned and for whatever
legal purposes it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of October 2020 at Davao
City, Philippines.

CHANYEOL PARK
Affiant

SUBSCRIBED AND SWORN to before me a Notary Public in the City of Davao, this 10th day of
October 2020 at Davao City, Philippines.

Doc. No. ____________;

Page No. ____________;
Book No. ___________;
Series of ____________.