LEGAL FORMS
FORM NO.1: AFFIDAVIT OF LOSS,
REPUBLIC OF THE PHILIPPINES)
)Ss.
AFFIDAVIT OF LOSS
IN A. ADARNA, messenger of Raphael Enrique V. Coronado,
of Legal Age, Filipino, Married, born on with residential address at 316 Palin
St, Block 27, Lot 77, Ai- Ai, General Tinio, GMA, Cavite, subseribing under
‘ath, hereby depose and state:
1. ‘That abovementioned is the plaintiff in the case of Spouses Coronado
‘v5 Pomtakers Industry Corporation filed in the Regional Trial Court of
Imus City, Cavite, Branch 22, for Annulment of Title with Damages;
2. Plaintiff is entitled to the relief demanded in the complaint in whole or
in part and such other relief consists in restraining the commission or
continuance of the acts complained of either for a limited peried or
perpetually;
3. The commission or continuance of the acts complained of during the
litigation will work injury to herein plaintiff and that the defendant is
doing, threatens, or is about to do, or is procuring or suffering to be
done the acts tending to render the judgment ineffectual;
4, That plaintiff is willing and ready to file a bond in the amount whieh
‘may be fixed by the Court to the effect that be, the plaintiff, will pay the
defendant all the damages which the latter may sustain by reason of the
15LEGAL FORMS
injunction if the court should finally decide that the plaintiff was not
entitled thereto,
ELLEN A. ADARNA
Atfiant
BEFORE ME, appears the person of ELLEN A. ADARNA
presenting the above Affidavit, who is personally known to me or identified
by me through competent evidence of identity as defined by the Notarial
Rules as the person who signs the document ancl in my presence taken an oath
or alfirmation before me as to such document
WITNESS MY HAND AND SEAL this 8 day of January, 2014 in
Imus City, Cavite
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Page No.
Book No.
Series of 2014,
SS
16LEGAL FORMS
FORM NO.4: ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF )Ss.
BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of
personally appeared with Community Tax
Cenificaie No, issued on at
(and Tax Identification No. (DLN.) ), known to me and to me
known 1o be the same person who executed the foregoing instrument which
(he'she) acknowledged to me as (his/her) free and voluntary act and deed,
consisting of only (___) page's, including this page in which this
Acknowledgement is written, duly signed by (hinvher) and (his/her)
instrumental witnesses on each and every page hereof.
WITNESS MY HAND AND SEAL this at .
Philippines.
NOTARY PUBLIC
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