Republic of the Philippines)

Province of Laguna ) S.S.

_____________________ )

AFFIDAVIT OF LOSS

That I, ADRIENNE V. GANACIAS of legal age, married to Melchor G. Ganacias, and resident of
Brgy. Patimbao,Sta.Cruz, Laguna, after being having been duly sworn on oath in accordance
with law hereby voluntarily depose and say;

1. That I ‘am the registered owner of a parcel of land situated in the Barangay of Patimbao,
Sta.Cruz, Laguna, As evidence of TCT No. T-2011003504, issued by the Register of Deeds
of Sta.Cruz, Laguna, containing an area of Sixty (60) SQAURE METERS.

2. That quite of accident on the 25th day of September 2022, more or less, me envelop
(folder) fell from my hand while I was on my way to Manila. That noted the loss only
when upon reaching my destination, I saw a folder was gone, together with my title TCT
No. T-2011003504 but to no avail;

3. That I am executing this affidavit to attest to all the above facts, and to request the
Honorable REGISTRY OF DEEDS of Sta.Cruz, Laguna to issue the new owners duplicate of
Title No. TCT No. T-2011003504

IN TRUTH WHEREOF, I have here unto set my hand this ___________ day of _______________
2022 at _____________________________.

ADRIENNE V. GANACIAS
Affiant

SUBSCRIBED AND SWORN to before me this ____________________, affiant exhibited to me his/her

Competent Evidence of Identity by way of __________________ issued at ______________ on
__________________________________.

Doc. No.___________
Page No. __________
Book No.___________
Series of ___________
Republic of the Philippines)
Province of Laguna ) S.S.
_____________________ )

AFFIDAVIT OF LOSS

That I, ADRIENNE V. GANACIAS of legal age, married to Melchor G. Ganacias, and resident of
Brgy. Patimbao,Sta.Cruz, Laguna, after being having been duly sworn on oath in accordance
with law hereby voluntarily depose and say;

4. That I ‘am the registered owner of a parcel of land situated in the Barangay of Patimbao,
Sta.Cruz, Laguna, As evidence of TCT No. T-2011003504, issued by the Register of Deeds
of Sta.Cruz, Laguna, containing an area of Sixty (60) SQAURE METERS.

5. That quite of accident on the 25th day of September 2022, more or less, me envelop
(folder) fell from my hand while I was on my way to Manila. That noted the loss only
when upon reaching my destination, I saw a folder was gone, together with my title TCT
No. T-2011003504 but to no avail;

6. That I am executing this affidavit to attest to all the above facts, and to request the
Honorable REGISTRY OF DEEDS of Sta.Cruz, Laguna to issue the new owners duplicate of
Title No. TCT No. T-2011003504

IN TRUTH WHEREOF, I have here unto set my hand this ___________ day of _______________
2022 at _____________________________.

ADRIENNE V. GANACIAS
Affiant

With Marital Consent:

MELCHOR G. GANACIAS

SUBSCRIBED AND SWORN to before me this ____________________, affiant exhibited to me his/her

Competent Evidence of Identity by way of __________________ issued at ______________ on
__________________________________.

Doc. No.___________
Page No. __________
Book No.___________
Series of ___________