REPUBLIC OF THE PHILIPPINES)

LAS PIAS CITY

)S.S.
AFFIDAVIT OF LOSS
I, , of legal age, Filipino, married and with residence and postal
address at, after being duly sworn to in accordance with law, hereby depose
and say that:
1. I am a holder of original certificate of full payment issued by
Pacific Plans under for educational plan.
2. Said certificate of full payment was inadvertently lost.
3. Inspite of diligent efforts to look for said certificate of full payment
all such efforts proved futile and in vain up to this time, thus, I am declaring
the loss of the said certificate of full payment.
4. I am executing this affidavit to attest to the truth of the foregoing
facts and for all its legal intents, effects, consequences and purposes.

Affiant
SUBSCRIBED AND SWORN TO BEFORE ME, this May 19, 2014 at
Las Pinas City, affiant with her LTO drivers license no. until 2/13/2015.
Page No.
Book No. 82
Series of 2014.