Affidavit of Loss (Lot Title)

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Republic of the Philippines )

Province of _________ )S.S.


___________________ )

AFFIDAVIT OF LOSS
I, __________,Married, of legal age, Filipino and a resident of Brgy. _______________,
after having duly sworn to in accordance with law, do hereby depose and state-

THAT, I am a holder of Lot Title No, ________________ from the __________ Brgy.
______________________,;

THAT, the said Lot Title No. ____________ has been destroyed by Termites at our
Residential House Brgy. _________________;

THAT, considering its destruction, the same is deemed lost and beyond recovery;

THAT, I am executing this Affidavit to attest to the veracity of the facts and for whatever
purposes it may serve under the law;

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


_____in the Municipality of ________, Province of __________.

_________________
Affiant

SUBSCRIBED AND SWORN to before me, on the date and in the place first above
written, by the Affiant who was made known to me to be the same person who executed the
foregoing Affidavit and identified by me through her competent evidence of identity, as above
stated. The Affiant avows under penalty of law as to the truth of her statements.

Doc. No.
Page No.
Book No.
Series of 2021

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