REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BATANGAS )
MUNICIPALITY OF LIAN )S.S.

AFFIDAVIT OF LOSS
OF TRANSFER CERTIFICATE OF TITLE

I, ______________________________________, of legal age,

_________, Filipino citizen and with residence address at
_________________________________ after having been duly sworn on
oath in accordance with law hereby voluntarily depose and state:

1. That I am the custodian of Title registered in the name of Ramon R.

Del Rosario, Jr. and covered by TCT NO. 103054, with an area of
Twelve Thousand Three Hundred Forty-One (12,341) Square
Meters and registered at the Registry of Deed of Nasugbu, Province of
Batangas.

2. That said title was inadvertently misplaced;

3. That despite my diligent effort to locate the same it is nowhere to be

found;

4. That I am executing this affidavit to attest to all the above facts and for
whatever legal intent and purpose this affidavit will serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature

below, this ____ day of October 2023 at Lian, Batangas.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me, this _____ day of

October 2023, by ____________________, who exhibited to me his I.D. with
No. ________________.

Notary Public

Doc. No. ___ ATTY. GERARDO R. MANALO

Page No. ___ Brgy. Matabungkay, Lian, Batangas
Book No. I Roll No. 42160
Series of 2023 PTR No. 31441816/Lian, Batangas
IBP No. 297229/Pasig
Until December 31, 2023
MCLE Compliance No. VII – 0027378
 _____ October 2023
______________________

The Registrar
Register of Deeds
Nasugbu, Batangas

Dear Sir:

This is to request your good office to kindly annotate the attached

Affidavit of Loss on the Original Transfer Certificate of Title No. 92185 on
file with your office. Attached please find copy of the Affidavit of Loss for
your reference.

Your kind assistance would be highly appreciated.

Thank you.

Sincerely,

_____________________