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REPUBLIC OF THE PHILIPPINES } S.

S
LIPA CITY, BATANGAS }

Affidavit of Loss
I, AIMEE I. DALANGIN, of legal age, Filipino, widow and
with residence address at 56 San Juan, Mabini, Batangas
after having duly sworn to in accordance with law, depose
and state that:
1. I am the beneficiary of memorial lots at ETERNAL
GARDENS MEMORIAL PARK CORPORATION, which is more
particularly described as:

AREA : Garden of Transfiguration


TYPE : Garden-Special Premiun
SECTION : B
BLOCK : 015
LOT # : 001-004

2. The Eternal Gardens Memorial Park Corporation had


issued to me the corresponding Certificate of Ownership #
03965 and Pre-Need Purchase Agreement with Contract #
01247;

3. The above mentioned documents were lost and


despite diligent efforts to locate the said documents the
same could not be found and/or its whereabouts could not be
ascertained;

4. The said documents have not been pledged,


mortagaged, assigned, conveyed and/or transferred to any
other party not served as collateral or security to any
liability;

5. I hereby undertake and by my self to assume all


liabilities and damages that may arise in the event that
the transfer of the lost documents in favor of another
party is found not in order, I hereby told ETERNAL GARDENS
MEMORIAL PARK CORPORATION free and harmless from any and
all such liabilities, damages or claims should there be
any;

6. I have this affidavit under pain of prosecution


for perjury, falsification and/or estafa in the event, the
information stated herein is found false;

7. I have executed this affidavit for whatever legal


purpose it may serve, and to attest to the truth of all the
foregoing statement.
IN WITNESS WHEREOF, I have hereunto affix my signature
this 8 April 2019 here at Lipa City, Batangas.
AIMEE I. DALANGIN
Affiant

SUBSCRIBED AND SWORN to me this 8 April 2019 here at


Lipa City, Batangas presenting to me her UMID with No. CRN-
0111-4628716-8 as proof of her identification.
WITNESS MY HAND AND SEAL on the date and place first
mentioned above.
Doc. No. 72
Page No. 15
Book No. LX
Series of 2019.

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