Republic of the Philippines)

Province of ____________)
Municipality of _________)

AFFIDAVIT OF LOSS

I, JESUS T. VENTURINA, of legal age, married, Filipino and a resident of B15 L19 Dreamland Hts
Subd United Bayanihan San Pedro Laguna, after being duly sworn to in accordance with law,
hereby depose and say:
1. That I know ____________________, owner of a parcel of land by virtue of a Deed of
Donation covered by Transfer Certificate of Title No. T-6936 still in the name of the
donors, _________________________ as she is a family friend;
2. That on November 15, 2021, __________________ entrusted to me the owner’s original
duplicate copy of the aforementioned title as she gave me authority to sell the same;
3. That after she gave me said certificate of title, I placed said document inside the cabinet
in our house where my other files are placed;
4. That every time an interested buyer wants to take a look of said title, I bring it with me
and place it back to said cabinet.
5. However, on February 14,2022, when an interested buyer wants to see the original
duplicate copy of the mentioned title, I was caught of caught by surprise when it was no
longer inside the said cabinet.
6. Thereafter, I made a diligent search not only inside the said cabinet, but also the entire
area of our house but I was not able to find it;
7. That after earnest efforts in finding said title were in vain, I asked my wife if she saw the
same but she answered in the negative;
8. That I informed ___________________ that the original duplicate copy of the
mentioned title was lost and I could not find the same despite earnest efforts;
9. That up to this time, the said title still cannot be found, hence, considered lost;
10. That I am executing this Affidavit to attest to all the above facts and to support the
petition of _______________ for the issuance of the new original owner’s duplicate of
title with number _______.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ____________ at
______________.

________________________
AFFIANT

SUBSCRIBED AND SWORN to before me this ___ day of NOVEMBER 2023 in the
city/municipality of ____________, petitioner exhibiting his/her DRIVER’S LICENSE ID No. D04-
13-013925.