REPUBLIC OF THE PHILIPPINES | S. S.

DONE: IN THE CITY OF BAGUIO |

AFFIDAVIT OF LOSS

I, , of legal age, single, Filipino, and a resident of Km. 5, La Trinidad,

Benguet, Philippines, after being sworn in accordance with law, hereby depose and state—

1. I am the purchaser / vendee of that parcel of land located at

containing an area of Two Hundred Square Meters covered by Transfer Certificate
of Title No. of the Registry of Deeds of Benguet—as evidenced by the Deed of Sale of a
Registered Land which was executed in my favor by and thereupon
acknowledged before Notary Public and docketed in his Notarial Registry as “Doc.
No. 427; Page No. 87; Book No. 12; and Series of 2007.” A copy of the said Deed of Sale of a
Registered Land is hereto attached and made an integral part hereof as ANNEX A.

2. Immediately after the Deed of Sale of a Registered Land was executed, the original duplicate
owner’s copy of Transfer Certificate of Title No. T-63274 was turned over to me by
He likewise delivered to me possession the subject parcel of land and since then I have
openly exercised and maintained all rights of ownership thereon.

3. I was not able to immediately effect transfer the title in my name because I was then
preoccupied with my studies at Aviator Flight School in Cebu City and at Clark Aviation School in
Clark Freeport, Pampanga. Sometime in April 2012, when I decided to process the transfer of the title in
my name, because I finally had the time and opportunity to do so, I discovered that the original
duplicate owner’s copy of Transfer Certificate of Title No. was missing. I could no longer find
it in my files. All diligent efforts I exerted to locate and retrieve it were in vain; hence for all legal
intents and purposes it is now deemed lost and beyond recovery.

4. I certify and confirm that the parcel of land covered by Transfer Certificate of Title No.
of the Registry of Deeds of Benguet was never mortgaged, sold, conveyed, disposed of, or
encumbered, to any other person or entity. I certify and confirm further that said document was neither
confiscated nor relinquished in favor of, any government entity agency, or authority.

5. I attest to the truth of the foregoing statements to the best of my own personal knowledge
and based on authentic documents or records. I am executing this Affidavit of Loss to support my
application for a new owner’s duplicate copy of Transfer Certificate of Title No. as well as for
all lawful intents and purposes it may serve.

IN WITNESS WHEREOF, I set my hand this 2nd day of July 2012 at Baguio City, Philippines.

Affian
t Driver’s License No.
Firearm License No.

SUBSCRIBED AND SWORN to before me this 2nd day of July at Baguio City,
Philippines.

ATTY. OSCAR A. CORPUZ, JR.

Notary Public
Until December 31, 2013
Doc. No. 189 N. A. No. 54-NC-12-R
Page No. 38 Attorney’s Roll No. 53486
Book No. III IBP No. 863438 01.02.2012 Baguio City
Series of 2012 PTR No. 0793799 01.02.2012 Baguio City
MCLE Compliance No. IV-0000200; 08.04.2010