REPUBLIC OF THE PHILIPPINES )

CITY OF MUNTINLUPA )S.S

AFFIDAVIT OF LOSS

KNOWN ALL MEN BY THESE PRESENTS:

I, LEAH LEGASPI PERUCHO, of legal age, Filipino, and a
resident of 730 Manuel L. Quezon St, Brgy Cupang, Muntinlupa City after
having been sworn in accordance with law, hereby deposes and states the
following:

1. I am the holder/owner/possessor of the documents: TCT-110039

named after David Santos married to Trinidad Fabian.;
2. A fire broke down last June 22, 2022 at our former residential address
at 815 San Roque, San Pedro City, Laguna.;
3. During the fire incident, TCT-110039 was burned, lost and destroyed
as evidenced by the Fire Report attached herein as Annex “A”;
4. I am executing this affidavit to inform those concerned about the loss
and destruction of the above mentioned items or documents;
5. I execute this affidavit to attest the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of

_______________. 2022 at Muntinlupa City.

LEAH LEGASPI
PERUCHO Affiant
 
SUBSCRIBED AND SWORN to me before me this ____ day of
___________, 2022 the affiant personally appeared and exhibited his
competent evidence of __________.

Doc No. ________

Page No. _________
Book No. __________
Series of 2022.