AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)

CITY OF IMUS) S.S.

I, ELWIN M. RUADO, Filipino, of legal age, residing at B9 L9 Kimberton Ville Niog 2,

Bacoor City, after having been sworn in accordance with law hereby depose and state:

That sometime in June of this year, I was looking for my original

Transcript of Records but to my surprise, said original Copy could not
found;

That I took pains to look for said Transcript of Records, but to no

avail;

That I am executing this affidavit to attest to the truth of the

foregoing and to request from the ________________________ to issue
a copy of the said Transcript of Records.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of

_______________. 2017___ at _________________________.

ELWIN M. RUADO

SUBSCRIBED AND SWORN to before me, this ____ day of ______________,

20___ in ___________________ City, with affiant exhibiting his CTC No.
_______________ ,
Issued on ______________________ at _________________________.

NOTARY PUBLIC
Until December 31, 2007___

Doc. No. : ________;

Page No. : ________;
Book No. : ________;
Series of 20_______.