Republic of the Philippines )

City of Davao ) S.S.

AFFIDAVIT OF LOSS

I, SAM O. LANGUNGAN and HAMDE O. LANGONGAN , of legal age, married, Filipino, and a
resident of Sta. Cruz, Davao del Sur, Philippines, after being sworn in accordance with law, hereby
depose and state;

1. That we are the heirs of RODOLFO L. LANGONGAN and SAUDA O.

LANGONGAN who is the registered owner of a parcel of land with Title
No. T-208754 located at Tibungco, Davao City;

2. Sometime in January 2017, when we decided to process the transfer of

the title in our name, because my parents are now both dead, I
discovered that the original duplicate owners copy of Certificate of Title
No. T-208754 was missing. I could no longer find it in my files. All
diligent efforts I exerted to locate and retrieve it were in vain; hence for
all legal intents and purposes it is now deemed lost and beyond
recovery.

3. We certify and confirm that the parcel of land covered by Certificate of

Title No. T-208754 was never mortgaged, sold, conveyed, disposed of, or
encumbered, to any other person or entity. I certify and confirm further
that said document was neither confiscated nor relinquished in favor of,
any government entity agency, or authority.

4. We attest to the truth of the foregoing statements to the best of our own
personal knowledge and based on authentic documents or records. I am
executing this Affidavit of Loss to support my application for a new
owners duplicate copy of Certificate of Title No. T-208754 as well as for
all lawful intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this February 20, 2017 at Davao City,
Philippines.

SAM O. LANGUNGAN HAMDE O. LANGONGAN

Affiant Affiant
VIN 2412-0159A-B1681SOL10001-7 Vin 2412-0159A-H2083HOL10001-5

SUBSCRIBED AND SWORN TO before me, this March 3, 2017 at Davao City,
Philippines, affiant personally appeared to me.

Doc. No.:
Page No.:
Book No.:
Series of 2017