REPUBLIC OF THE PHILIPPINES)

TARLAC CITY…….. ) S.S.

AFFIDAVIT OF LOSS
I, WENIE J. RAPINAN, of legal age, Filipino, married, with residence of and postal
address at Barangay Bobon 2, 289 Purok Justice, Camiling, Tarlac, Philippines, after
having duly sworn to in accordance with law, do hereby depose and state;
1. I am the owner of a parcel of land covered by Transfer Certificate of Title
(TCT) No. 92356 of the Registry of Deeds, Province of Tarlac, located in
Camiling, Tarlac, with an area of 6,016 square meters, a copy of TCT NO.
92356 is hereto attached as Annex “A”;

2. My ownership over the subject parcel of land is evidenced by an EXTRA

JUDICIAL SETTLEMENT OF ESTATE WITH DEED OF ABSOLUTE SALE,
a copy of which is hereto-attached as ANNEX “B”;

3. Upon consummation of the sale, the subject parcel of land was delivered to
me as a buyer including the owner’s copy of TCT No. 92356;

4. Recently, in order to facilitate the titling and registration of the subject parcel
of land in my name, I searched for the owner’s copy of TCT No. 92356 which
I had safe kept in the said filing cabinet, however, the same could no longer
be found;

5. I have exerted efforts to locate the owner’s copy of TCT NO. 92356, but all
proved futile.

6. I am executing this affidavit to attest to the truth of the foregoing declarations

and for whatever legal intent for purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

Tarlac City, Philippines.

WENIE J. RAPINAN
Affiant

SUBSCRIBED AND SWORN to before me this ___________________, at Tarlac

City, Philippines.

Doc No. ___________ ;

Page No. __________ ;
Book No. __________ ;
Series of 2018