REPUBLIC OF THE PHILIPPINES )

TN THE CITY OF CABANATUAN ) S.S.

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AFFIDAVIT OF LOSS

WE, NELICIA S. JAVILLO and BENJIE M. SIMON, both of legal ages,

Filipinos and residents of Sto. Rosario Young, Zaragoza, Nueva Ecija after having been
duly sworn to in accordance with law, do hereby depose and state:

1. That we are the legal heirs of our late parents Celestino Simon and Amelia
Morales Simon who died intestate on August 11, 1998 in Manila and July 16,
2009 in U.S.A. as evidenced by a copy of our respective Birth Certificates hereto
attached as ANNEX “A” and ANNEX “B”;
2. That, during the lifetime of our late parents they are the registered owner of
Original Certificate of Title No. 22815 situated in the Barrio of Sto. Rosario,
Municipality of Zaragoza, Nueva Ecija containing an area of Twenty Three
Thousand Seven Hundred Forty Eight (23,748) Square Meters, more or less;
3. That, we know the fact of the said title because during the lifetime of our late
parents the original copy was placed inside our filing cabinet for safekeeping
purposes;
4. That sometimes in the year 2009 before we proceed to Maryland U.S.A. we
conduct and made an inventory of all important documents, we noticed that the
said title was lost and or misplaced without our knowledge;
5. That despite of diligent efforts to locate the same, all said efforts proved to be in
vain;
6. That the said title was never been mortgage to any government or private bank
whatsoever;
7. That, we are executing this Affidavit in order to attest to the truth of the foregoing
facts and to request the Registry of Deeds for the Province of Nueva Ecija to issue
a new title in lieu of the lost one and for whatever legal intent and purpose it may
serve.

IN WITNESS WHEREOF, we have hereunto affixed our hands this ___ day of
______________, 2018 hereat Cabanatuan City.

NELICIA S. JAVILLO BENJIE M. SIMON

Affiant Affiant
ID No. ID No.
Issued By: Issued By:

SUBSCRIBED AND SWORN to before me this day of _____, day of

_______________, 2018 affiants personally appeared with a valid proof of
identification, details are written above, hereat Cabanatuan City.

Doc. No.
Page No.
Book No.
Series of 2018