Republic of the Philippines )

Province of Bukidnon ) S.S.

City of Malaybalay )

AFFIDAVIT OF LOSS TITLE

We, AAA, BBB, CCC, DDD, and EEE all of legal age, Filipino citizens,
residents of M.L. Quezon Street, Poblacion Valencia City, Bukidnon, after having
been duly sworn to in accordance with the law do hereby depose and say:

That we are the heirs of the late FFF, the registered owner of a parcel of
land situated in the Barrio of Tagustus, Municipality of Valencia, Province of
Bukidnon covered by Transfer Certificate of Title No. T-0000, issued by the
Register of Deeds of Malaybalay City, Bukidnon, containing an area of ONE
THOUSAND (1,000) SQUARE METERS, more or less;

That upon his death, we discovered that the duplicate/owner’s copy of TCT
No. T-0000 was lost and all efforts exerted to find and locate the same but to no
avail;

That we are executing this affidavit to attest to all the above facts, and to
request the REGISTER OF DEEDS of Malaybalay, Bukidnon to issue the new
owner’s duplicate copy of title of Title No. T-0000;

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___

day of ___________, 2019 at Malaybalay City, Bukidnon, Philippines.

AAA BBB
Affiant Affiant
TIN No. 191-201-714 TIN No. 190-972-602

CCC DDD
Affiant Affiant
TIN No. 926-394-781 TIN No. 938-269-849

EEE
Affiant
TIN No. 263-715-569

BEFORE ME, a Notary Public for and in the Province of Bukidnon,

personally appeared AAA, BBB, CCC, DDD and EEE, exhibited to me their valid IDs
and known to be the same persons who executed the foregoing instrument
consisting that the same is their free and voluntary act and deed.

WITNESS MY HAND AND SEAL, this ___ day of ___________, 2019 at

Malaybalay City, Bukidnon, Philippines.

Doc. No. ________

Page No. ________
Book No. ________
Series of 2019