REPUBLIC OF THE PHILIPPINES)

PROVINCE OF AKLAN )S.S.

MUNICIPALITY OF KALIBO )
x-------------------------x

AFFIDAVIT OF LOSS

I, ______________________, of legal age, married, Filipino Citizen, and

resident of Brgy. Sibalew, Libacao, Aklan, Philippines, after being duly sworn in
accordance with law, depose and state:

1. That I was issued a Certificate of Stewardship Contract (CSC) No.

____________________ by the Department of Environment and Natural
Resources (DENR) of Kalibo, Aklan, Philippines;

2. Said CSC covers a portion of land which I have occupied with an area of
more or less 0.85 hectares located at Brgy. Sibalew, Libacao, Aklan,
Philippines;

3. That sometime on July, 2010, I misplaced and could no longer find the
said Certificate of Stewardship Contract (CSC) No. 0603091468-C;

4. That despite diligent search and efforts to locate the said document, I
could no longer find the same such that I believe that they are now lost
beyond recovery;

5. That said loss was neither due to any liens or encumbrances in favor of
any person or entity and as such, I do hereby undertake to shoulder any
and responsibilities subject thereto;

6. That I am executing this Affidavit of Loss to attest to the truth of the

foregoing and for all legal intents and purposes and

IN TESTIMONY WHEREOF, I have hereunto set my hand this 9 day of

April, 2019 at Kalibo, Aklan.

______________________
Affiant
OSCA ID No. ___________________
Date of registry: April 19, 2010
Place of issue: Libacao, Aklan

SUBSCRIBED AND SWORN to before me this 1st day of April, 2019 at

Kalibo, Aklan, Philippines by _____________________ who is personally known
to me and known to me to be the same person who signed the foregoing
Affidavit and acknowledged that she executed the same.