REPUBLIC OF THE PHILIPPINES)

DAVAO CITY ) S.S.

x --------------------------------------x

AFFIDAVIT OF LOSS

I, John dela Cruz, of legal age, Filipino, single, and a resident of

Matina Aplaya, Davao City, after having been sworn in accordance with law,
hereby deposes and states the following:

1. I am one of the heirs of the deceased Alexander dela Cruz, the registered
owner of a parcel of land situated at Matina Aplaya, Davao City with
the Lot No. 1994, Cad 670, and Transfer Certificate of Title (TCT) No.
123456.

2. On January 5, 2021, while I was arranging my deceased father’s file

cabinet in his office where he keeps all legal documents, I noticed that
the Owner’s TCT No. 123456 was missing.

3. The last time I saw this document was when I helped my father clean
his file cabinet December 31, 2019.

4. Despite due efforts to locate the same, both in my father’s office and
residence, the Owner’s Copy of the TCT No. 123456 could not be
found.

5. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

John dela Cruz

Competent Evidence of Identity:____

ID No:____
Issued on: ___
At: ____

1
 JURAT

SUBSCRIBED and SWORN TO before, in the City of Davao, this 16th

day of January 2021 by John dela Cruz with ID No. ____ issued at ______ on
the date and at the place indicated below. The affiant exhibited to me his
competent evidence of identity as indicated above.

WITNESS MY HAND AND SEAL.

ATTY. FLORENCE CAMACHILE

Notary Public for Davao City
Roll No.: 83712
Commission Serial No. 2020-213-
2021
Until December 31, 2021
IBP No. 621721, January 6, 2020,
Davao City
PTR No.086344 January 6, 2020,
Davao City
CAMACHILE LAW OFFICE
Lopez Bldg., Davao City

Doc. No. 1;
Page No. 1;
Book No. I;
Series of 2020