REPUBLIC OF THE PHILIPPINES )

PROVINCE OF AGUSAN DEL SUR )SS

MUNICIPALITY OF SAN FRANCISCO)

AFFIDAVIT OF LOSS

I, PEPITO A. CARTAGENA, of legal age, Filipino and a

resident of San Vicente, Barobo, Surigao del Sur after
being duly sworn to in accordance with law hereby depose
and say:

(1) That I am the same person above-mentioned;

(2) That I am the registered owner of Lot No. 110,

Psd-11-045785 (AR) covered by Transfer Certificate
of Title No. T-4228 with an area of Seventeen
Thousand Four Hundred Twenty One (17, 421) sq.
meters, situated at San Vicente, Barobo, Surigao
del Sur;

(3) That sometime in December 2021, typhoon Odette

hit some areas of the Philippines including
Province of Agusan and Surigao del Sur. During
that time, my residence was flooded and several of
my belongings were damaged;

(4) That after said typhoon, I discovered that

Transfer Certificate of Title No. T-4228 was
missing and despite diligent effort to search said
TCT No. T-4228, the same cannot be found anymore;

(5) That I am executing this affidavit to show the

fact of loss of said Transfer Certificate of Title
No. T-4228 over Lot No. 110, Psd-11-045785 (AR)in
support of our request for the issuance of another
Title in lieu of the lost one with the same
particulars as to the name of the title holder,
location of property, size of property, boundaries
and others.

IN WITNESS WHEREOF, I have hereunto set my hand this 25th

day of April 2022 at San Francisco, Agusan del Sur.

PEPITO A. CARTAGENA
(affiant)

SUBSCRIBED AND SWORN to before me this 25th day of April

2022 at San Francisco, Agusan del Sur.

Doc No.
Page No.
Book No.
Series of 2022