Republic of the Philippines }

Province of Davao del Norte }s.s.

City of Panabo }

AFFIDAVIT OF LOSS

I, ELIZABETH PLASABAS, of legal age, Filipino, married, and a resident of 0079 Purok
2, Barangay San Vicente, Panabo City, Davao del Norte, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and say:

1. That I, through a special power of attorney, have been appointed by my brother,

POLICARPIO G. CURAY, as his attorney-in-fact to withdraw and/or release his
ORIGINAL CERTIFICATE OF TITLE NO. P-43022;
2. That pursuant to said special power of attorney, the Registry of Deeds of the
Province of Davao del Norte released to me the aforementioned certificate of title;
3. That said certificate of title, while in my possession, was misplaced and could no
longer be located in spite of exerting efforts to locate it;
4. That said certificate of title is not in the possession of any creditor by reason of any
encumbrance or real estate mortgage of the parcel of land covered by the subject
certificate of title;
5. That I am executing this affidavit to attest to the truth of the foregoing facts and to
support the application for a new owner’s duplicate copy of ORIGINAL
CERTIFICATE OF TITLE NO. P-43022.

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

Panabo City, Davao del Norte, Philippines.

ELIZABETH PLASABAS
Affiant
SSS ID # 09-1259674-1

SUBSCRIBED AND SWORN to before me this ________________ at Panabo City, Davao

del Norte, Philippines, affiant exhibiting the ID stated above as competent proof of identity.

Doc. No.: ___;

Page No.: ___;
Book No.: ___;
Series of 2018.