Republic of the Philippines )

City of Pasig ) S. S.

JOINT AFFIDAVIT OF LOSS

We, , Filipinos and all of legal age, after having been jointly sworn to in accordance with
law, hereby depose and allege:

1. That we are the true owners of the mortuary plot belonging to our late parents
located at;
2. That our ownership over the mortuary plot was evidenced by a [CERTIFICATE OF
TITLE]
3. That sometime on [date], we discovered that the [CERTIFICATE OF TITLE] was
no longer in the location where we stored it previously;
4. That our diligent efforts to locate the same have proved futile;
5. That we are executing this affidavit to attest to the truth of the foregoing facts
and to request for a replacement [CERTIFICATE OF TITLE].

IN WITNESS WHEREOF, WE HAVE HEREUNTO AFFIXED OUR SIGNATURES THIS __ day

of ____ 2017, at Pasig City, Philippines.

[signatures]

SUBSCRIBED AND SWORN TO before me this _____ day of ________ 2017 at

_________________, affiants exhibiting to me their TIN:
[TIN follows]

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2017.