REPUBLIC OF THE 

PHILIPPINES)
           ) S.S.
x----------------------------x
  
AFFIDAVIT OF LOSS

  I, DARWIN C. CRUZ, of legal age, Filipino, married, and a  resident

of 277 Ilang-Ilang St. Green Heights Newtown Subdivision, Brgy. Mayamot,
Antipolo City, after having been duly sworn to in accordance with law,
depose and state that:

1. I am the son and one of the Heirs of the late Montano S. Cruz.

2. Sometime in 1992, my father applied for a Subdivision(LRA)

Plan PD
with PSD-
350054 at Land Registration Authority, Quezon City.

3. That after his death, we decided to subdivide the same property located at
Brgy. Bagumbayan, Quezon City, now with a different perspective of
Subdivision.

4. That the LRA, Quezon City is asking for an original copy of the Original
Subdivision Plan, purposely for the cancellation of the existing Subdivision
Plan.

5. Efforts were exerted to locate the said document, but in spite of diligent
search, it could not be found and the same is now beyond recovery;

6. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support my application for the Cancellation of the
Subdivision Plan PSD-350054.

IN WITNESS WHEREOF, I have hereunto set my hand

this ___________________ in _______________________, Philippines.

DARWIN C. CRUZ
Affiant
UMID#006-0066-9605-6

  SUBCRIBED AND SWORN TO before me this _______________ in

_________________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of __________________ issued at
______________ on _________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.