Republic of the Philippines )

Camiling, Tarlac
) S.S.

AFFIDAVIT OF LOSS
I, NICK JOHN AGUSTIN y GALAPON, 20 years old, Filipino citizen,
single and a resident of Barangay New Salem, Gerona, Tarlac, after having
been sworn to in accordance with law, do hereby depose and state THAT:
1. I was issued by the Technical Education Skills Development
Authority (TESDA) a TESDA Animal Production NC II Certificate
after completing the required program sometime in 2014 at the
Tarlac College of Agriculture, Camiling, Tarlac;
2. I kept the said NC II certificate, together with my other personal
documents, in one of the drawers inside my room;
3. Lately, while I was organizing my personal effects, I discovered that
the above-said certificate was missing;
4. I immediately searched the said certificate in the other drawers in
our house but I found nothing. I also asked the members of our
household if they have found the same but all answered in the
negative;
5. All my diligent efforts exerted to locate the said TESDA Animal
Production NC II certificate proved futile; hence, I now consider the
same as lost and beyond recovery;
6. I am executing this affidavit to attest to the truth of the foregoing
statements and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 22 nd day
of February, 2016 at Camiling, Tarlac, Philippines.
NICK JOHN G. AGUSTIN
Affiant
SUBSCRIBED AND SWORN to before me on the date and place
indicated above. Affiant exhibited before me his School Identification Card
with Student Number 2012100062 issued by the Tarlac College of
Agriculture, Camiling, Tarlac.

Doc. No. _____; Page No. _____; Book No. _____; Series of 2016.