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Republic of the Philippines ))

City of Calbayog )) s.s.

AFFIDAVIT

I, EVANGELINE OITE LABONG, Filipino, 42 years of age, married,


and presently a resident of Barangay Obrero, Calbayog City, Samar, Philippines,
after having been duly sworn to in accordance with law, hereby depose and state,
that--

1. A fire incident transpired on 22 January 2019 in the evening totally


damaging our residential house located at P-3, Barangay Obrero,
Calbayog City. The said incident was duly documented and recorded by
BFP Calbayog City as evidenced by a Spot Investigation Report herein
attached;

2. As a result of such fire, several documents and Identification cards, which


were inside the house, were burned and were totally damaged and hence
cannot be recovered at all;

3. Among those documents are as follows:

a. DepEd Appointment Certificate


b. DepED Special Orders
c. College Transcript of Records
d. HS, College, and MA program Diplomas
e. DepEd Payslips from 2015-2018

4. I am executing this Affidavit to attest to the truth of the foregoing facts


and to support my application and request for the issuance the same at
DepEd and respective institutions and for whatever legal purpose this
may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of


January 2019, at Calbayog City, Samar, Philippines.

EVANGELINE OITE LABONG


Affiant
UMID CRN: 011-1250-3997-1

SUBSCRIBED AND SWORN TO BEFORE ME, this 24th day of January


2019, at Calbayog City, Samar, Philippines.

ATTY. ALJUN B. DIAZ


Public Attorney I
Pursuant to RA 9406

Doc. No. 52;


Page No. 03;
Book No. I
Series of 2019