REPUBLIC OF THE PHILIPPINES

} } S.S.

AFFIDAVIT OF LOSS
I, METRENA CASIMIRO, of legal age, Filipino, and with postal address at #42-A P. Florentino St., Brgy. Lourdes, Q. C., after having been duly sworn to in accordance with law, hereby deposes and states: 1. That I am the owner of a parcel of land covered by Transfer Certificate of Title No. 79438 situated in the Municipality of Asingan issued by the Registry of Deeds for the Province of Pangasinan; 2. That the duplicate copy of Transfer Certificate of Title No. 79438 was misplaced and/or lost and could no longer be recovered despite diligent efforts exerted by me. 3. That said duplicate copy of Transfer Certificate of Title No. 79438 had not been delivered to any person or entity to secure payment or performance of any obligation whatsoever, and is free from liens and encumbrances at the time of its loss. 6. That upon discovery, I immediately searched for the said Title at the most probable places I might have placed it but the same was nowhere to be found; 7. That despite my earnest efforts, I was unable to locate the said Title. Hence, there is now a reasonable ground to believe that the aforesaid Title is now lost and beyond recovery; and 8. That I am executing this Affidavit of Loss to attest to the truth of the foregoing facts and to be used for whatever legal purpose(s) it may serve. FURTHER AFFIANT SAYETH NAUGHT. IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________ 2013. METRENA CASIMIRO Affiant SUBSCRIBED AND SWORN to before me this _____ day of __________ 2013, affiant exhibited to me her Senior Citizens ID No. 175270.

NOTARY PUBLIC Until December 31, 20__ Doc. No. ___; Page No. ___; Book No. ___; Series of 2013.

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