Republic of the Philippines)
Province of Isabela ) S.S.
City of Cauayan )
AFFIDAVIT
I, ________________________, Filipino of legal age, single/married/widow/other and a resident of
____________ Province of_____________, Philippines after having been sworn in accordance with the
law depose and state;
1. That I am the registered owner mortgagee
owner/co-owner Others (please specify.
of the parcel of land covered by Original/Transfer Certificate of Title Nos. _____________ of the
registry of Deeds of____________(Important: Please check appropriate box above)
2. That the original copy of the aforesaid Original/Transfer Certificate of Title on file with the
Registry of Deeds of _________________ was lost/destroyed due to _____________________.
3. That no deed of other instrument affecting the property has been presented for registration or if
there be any, the nature thereof, the date of its presentation as well as the names of the parties and
whether the registration of such deeds or instruments is still pending accomplishment;
4. That the owners duplicate certificate or co-owner's duplicate is in due form without any
intentional alteration or erasures;
5. That the certificate of title is not the subject to litigation or investigation, administrative or
judicial regarding its genuineness or due execution or issuances;
6. That the original certificate of title was in full force and effect at the time it was lost or destroyed;
7. That the certificate of title is covered by Tax Declaration regularly issued by the Assessor's
Office;
8. That the real estate taxes have been fully paid up to at least two (2) years prior to the filling of the
petition for reconstitution;
9. That the corresponding co-owner's duplicate copy of the said Original/Transfer Certificate of
Title No/s. ______________________ was lost/destroyed in the possession of
____________________.
UNDER THE FOLLOWING CIRCUMSTANCE:
(state below the circumstance) ________________________________
________________________________
________________________________
Note:
Par. 9 should be filled up only in case the co-owner's duplicate is to be made for reconstitution.
10. That the owner's duplicate certificate is being submitted as basis for administrative
reconstitution pursuant to Rep. Act No. 6732;
11. That I am executing this affidavit in connection with my petition for administrative
reconstitution of the Original/Transfer Certificate of Title No/s.
Further affiant sayeth none.
__________________________
Affiant
SUBSCRIBED AND SWORN TO before me this __________________ at _______________ affiant
exhibited to me his/her Community Tax Certificate No. ________ issued
on___________at______________, Philippines.
Doc. No.
[Link].2016.002
Revision 1/06-06-2016
Page No. Notary Public
Book No.
Series of 2023
[Link].2016.002
Revision 1/06-06-2016