You are on page 1of 3

Republic of the Philippines )

City of Bacolod )s.s.


x--------------------------------------x

AFFIDAVIT OF LOSS

I, CHARLES PHOEBELMER G. BALBIN, of legal age, a Filipino,


single, and a resident of Bacolod City, Philippines, under oath,
do hereby depose and state: THAT –

1.) I am the registered owner of a parcel of land known


as Lot 2, Block 39, covered by Transfer Certificate of
Title No. T-123456 of the Registry of Deeds of Bacolod
City.

2.) As proof of my ownership over Lot 2, Block 39, I was


issued an Owner’s Duplicate of Transfer Certificate of
Title No. T-123456 which I kept inside my fireproof
and bulletproof vault inside my bedroom.

3.) Last January 1, 2019, a burglar entered my house and


took away with him several of my belongings
including the vault which contained several important
documents which includes the Owner’s Duplicate of
Title No. T-123456.

4.) I have reported the said incident to the authorities


and even exerted effort to locate and recover my lost
Owner’s Duplicate of Title No. T-123456 but the same
is now beyond recovery.

5.) I did not deliver the said Owner’s Duplicate of Title


No. T-123456 as security for the payment of any
outstanding obligation and was lost due to the
circumstances narrated above.

6.) I am executing this affidavit to attest to the truth of


the foregoing and for purposes of reporting the loss
of my title and in support of the petition I intend to
file for issuance of a duplicate of the lost title.

IN WITNESS WHEREOF, I have hereunto affixed my


signature this 18th day of January 2019 at Bacolod City,
Philippines.

CHARLES PHOEBELMER G. BALBIN


Affiant

SUBSCRIBED AND SWORN TO before me this 18 th day of


January 2019 at Bacolod City, Philippines, affiant personally
appeared before me and exhibited to me his SSS Id. No.
_____________ as competent proof of his identity.

Doc No.___
Page No __
Book No __
Series of 2019.