REPUBLIC OF THE PHILIPPINES) SS

CITY OF DUMAGUETE)

AFFIDAVIT OF LOSS

I, Silvestra Dagoy, Filipino, of legal age and a resident of Jawa, Valencia, Negros
Oriental, after being sworn in accordance with law, hereby state and declare:

That I am the true owner of a parcel of land situated in Jawa, Valencia, Negros
Oriental and covered by the Transfer Certificated of Title No. T-1181;

That I diligently kept my Torrens Title rolled inside a cut bamboo node and kept it
inside a locked cabinet;

That I wanted to sell the property and retrieved my owner’s copy of the title.
Unfortunately, the title was eaten by some insects and all I found was bits and pieces of what
was left of the title inside the bamboo;

The Owner’s Duplicate Copy of Transfer Certificate of Title no. T-1181 is now
beyond recovery;

That I am executing this affidavit to attest to such loss in connection with my desire to
be issued a New Owner’s Duplicate copy of the said certificate by the Office of the Register
of Deeds of the City of Dumaguete;

FURTHER I SAY NONE.

SILVESTRA DAGOY
Landowner-Affiant

SUBSCRIBED AND SWORN TO before me this 22th day of August, 2010 in Dumaguete
City.

KARISSA FAYE R. TOLENTINO

NOTARY PUBLIC
Until December 31, 2010
College of Law
Tel. # 422-6003 local 306
PTR No. xxx; Dumaguete City
IBP OR No. xxx; Neg. Or. Chapter
Roll No. xxx; MCLE No. xxx

Doc. No. ___

Page No. ___
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Series of 2010