AFFIDAVIT OF LOSS

I, AILA NATALIE JUANIO PATEL, married, Filipino, of legal age and with
residence address at ______________________________ City, after having been duly
sworn to in accordance with law hereby depose and state:

1. I am one of the legitimate heirs and the surviving and legitimated children of
deceased Spouses Francisco G. Juanio and Ingrid A. Malabanan-Juanio;

2. I, along with my siblings, have executed an Extra Judicial Settlement of the Estate
of our deceased parents for the processing of the Estate Tax Amnesty this May
2021;

3. That one of the properties left by our deceased parents is a parcel of land located
at ________________ City, containing an area of One Hundred Eighty Nine
Square Meters (189) square meters (sq.m.) covered by Transfer Certificate of
Title No. ______________;

4. That in the course of collating the documentary requirements for the filing of the
Estate Tax Amnesty sometime this May 2021, I discovered that the owner’s
duplicate copy of the reconstituted Transfer Certificate of Title No.
____________ is missing. I could not find it in our files;

5. All diligent efforts exerted to locate and retrieve it were in vain, hence for all legal
intents and purposes the above-mentioned document is now deemed lost and
beyond recovery;

6. I certify and confirm that the parcel of land covered by Transfer Certificate of
Title No. ___________ of the Registry of Deeds of _____________ City has not
been subject to any foreclosure proceeding by any entity, public or otherwise.

7. I attest to the truth of the foregoing statements to the best of my personal

knowledge and based on authentic documents or records, and for the purpose of
requesting for reissuance of the title in place of the lost ones, and for whatever
legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto signed my name this ___________

2021, in _____________, Philippines.

____________________
Affiant

      SUBSCRIBED AND SWORN to before me this ____________ 2021, in

_____________, Philippines. Affiant exhibited to me her competent evidence of identity
her ________________________.

Notary Public
Doc. No____;
Page No. ___;
Book No. ___;
Series of _____.