Affidavit of Loss

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(Affidavit of Loss contract/certificate of ownership)

Republic of the Philippines)


Province of__________________) S.S.
City/Municipality of_____________)
x-----------x

AFFIDAVIT OF LOSS

I, BARON F. MIRAFLOR, Filipino, of legal age, married, and a resident of #45


M.L. Quezon St., Phase 7B, Block 2 Lot 5, Pacita Complex I, San Pedro,
Laguna, Philippines, after being duly sworn in accordance with law, depose
and state:

That I am the authorized representative of SPS. and Drs. CEFERINO and


MARIETTA MIRAFLOR-BAGUE by virtue of an authorization letter to transact
on their behalf pertaining to the memorial lot with Everest Hills Memorial
Park with the following details below;

PNPA # 1738
CO. # 93-00388
Purchaser : Ceferino F. Bague, M.D.
Garden of Unity Section D, Block 106, Lot 7&8

That the contract / certificate of ownership of the abovementioned memorial


lot was in the possession of my deceased father, BARTOLOME L. MIRAFLOR,
JR., M.D., who passed away last March 13, 2017.

That sometime this week, the original copy of the said contract/certificate of
ownership could not be found and that despite of diligent search and efforts,
the same could no longer be found such that I now believe that it is now lost
beyond recovery.

As such, I am executing this Affidavit of Loss to attest to the truth of the


foregoing and for whatever legal purposes that this may serve.
IN WITNESS WHEREOF,I have hereunto set my hand this
_____________at_____________, Philippines.

AFFIANT

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