ORepublic of the Philippines)

Province of ____________________)S.S.
City/Municipality of _____________)
x-------------x

AFFIDAVIT OF LOSS
I, (____________)Filipino, of legal age,single, and a resident of St. Thomas Peter
Barangay Binunay Quezon City, after being duly sworn in accordance with law,
depose and state:

1) That I am the true and registered owner of a certain parcel of land which
is covered by Transfer Certificate of Title No. ____________, more
particularly described as follows: (Technical Description of Property)

2) That annotated on said Transfer Certificate of Title No. ______________ are

the following entries, to wit:

3) That the effectivity and efficacy of said entries have since expired as
shown by the dates thereon and/or were correspondingly superseded by
other entries which are also being caused to be cancelled in view of the
fact that the party to said annotation has registered no opposition to its
cancellation.

4) That I am executing this affidavit purposely requesting the Register of

Deeds to cause the cancellation of the above-mentioned entries in the
aforementioned Transfer Certificate of Title.

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

_____________, Philippines.

SUBSCRIBED AND SWORN TO before this ___ day of __________, affiant

exhibiting to me her ( ____________)and known to me to be the same person
who personally signed the foregoing Affidavit and acknowledged that she
executed the same and avowed under penalty of law the truthfulness of the
foregoing statements.

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