REPUBLIC OF THE PHILIPPINES)

CITY OF QUEZON) SS
AFFIDAVIT OF LOSS

I, Ferdinand Santos, Filipino, of legal age and a resident of Barangay Culiat,

Quezon City, after being sworn in accordance with law, hereby state and declare:
1. That I am the true owner of a parcel of land situated in Barangay Balara,
Quezon City containing an area of 900 sq. m and covered by the Transfer Certificated of
Title No. T-1281;
2. That during Ondoy, sometime September 2009, the flood waters swept all our
belongings including the plastic safety box containing the subject Torrens title and
despite diligent efforts to retrieve and locate the Owners Duplicate Copy of Transfer
Certificate of Title no. T-1281, it is now beyond recovery;
3. That I certify and confirm that the parcel of land covered by Transfer
Certificate of Title no. T-1281was never mortgaged, sold, conveyed, disposed of, or
encumbered, to any other person or entity. I certify and confirm further that said
document neither was neither confiscated nor relinquished in favor of, any government
entity agency, or authority.
4. That I attest to the truth of the foregoing statements to the best of my 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 Transfer
Certificate of Title No. T-1281 as well as for all lawful intents and purposes it may serve.
FURTHER I SAY NONE.
IN WITNESS WHEREOF, I set my hand this 22nd Day of February 2011 At Quezon City,
Philippines
FERDINAND SANTOS
Landowner-Affiant
SUBSCRIBED AND SWORN to before me this 22th day of February, 2011 in Quezon City.
ATTY. CARMELA TY
NOTARY PUBLIC
Until December 31, 2011
N.A. No.xxx
Roll No. xxx;
IBP No. xxx; Quezon City Chapter
PTR No. xxx; Quezon City
MCLE Compliance No. xxx
Doc. No. ___
Page No. ___
Book No. ___
Series of 2011