You are on page 1of 1

REPUBLIC OF THE PHILIPPINES)

CITY OF CALOOCAN )S.S.

AFFIDAVIT OF LOSS

We, RIZZA T. DEL CARMEN and JOSE R. DEL CARMEN JR. of legal
ages, Filipino citizen and with residential address at 0886 Danga, Colgante,
Apalit, Pampanga, after having been sworn to in accordance with law hereby
depose and state;

1. That we are purchaser of a residential house from Asian Land


Strategies Corp. located at Block 22, Lot 7, Grand Royale 5-B,
Bulihan, Malolos, Bulacan;

2. That payments in installment was made thru us who kept the


OFFICIAL RECEIPT Nos. 559953, 571645, 379947, 344583, 360272,
367190, 368730, 373802, 379449, 384231, 399972, 406043, 408136,
416529, 421089, 433059, 433077, 441508, 446977, 451740, 458344,
462769, 465341, 472402, 478170, 478171, 490820, 506467, 555716,
559953, 571645, B40343, and 588479;

3. That lately however, when we were looking for said OR’s from our
files at home, the same was lost/misplaced and nowhere to be
found;

4. That despite diligent efforts to locate the said OR’s proved futile.

5. That we are executing this affidavit in order to attest to the truth of


the foregoing facts and circumstances behind the loss of the said
Official Receipts from Asian Land Strategies Corp. and for
whatever legal purpose this may serve.

FURTHER AFFIANT SAYETH NAUGHT.

Done this 23rd day of March 2009 at the City of Caloocan, Philippines.

RIZZA T. DEL CARMEN JOSE R. DEL CARMEN JR.


Affiant Affiant

SUBSCRIBED AND SWORN to before me a Notary Public for and in the


City of Caloocan this 23rd day of March 2009.

Doc. No. ____


Page No. ____
Book No. ____
Series of 2009

You might also like