REPUBLIC OF THE PHILIPPINES)

CITY O MANILA ) S.S

AFFIDAVIT OF LOSS

I, CESAR J, PEÑOSO, of legal age, Filipino, married, and with residence of Dagat K
Davao, Valencia City, under oath, depose and state that:

1. I am the registered owner of the land with Transfer Certificate of Title - ET-:

2. Said Receipts were safely kept inside my bag; however, my bag was lost in transit
when I traveled from Manila to my hometown here in bukidnon.

3. I have exerted all efforts to locate my bag, but despite all the effort, I could not find
the same.

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

September 2020, IN Manila, Philippines.

CESAR J, PEÑOSO
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of September 2020 in

Quezon City Philippines. Affiant exhibited to me his competent evidence of identity as
__________________.

Notary Public

Doc. No____;
Page No. ___;
Book No. ___;
Series of 2020.