Republic of the Philippines]

Legazpi City ]
x--------------------------------x

AFFIDAVIT OF LOSS

I, LOLITA I. NARCE, of legal age, Filipino citizen, widow, and a resident of Imperial
Subdivision, Polangui, Albay, after having been duly sworn to in accordance with law, do
hereby depose and state, that:
1. I am a member of the Manila Teachers’ Mutual Aid System with Account No. 3-607-
07-000876;
2. Being a member of the said organization, I was also issued a Membership
Certificate, the details of which I can no longer recall;
3. Sometime in November 2006, I lost the said membership certificate when our
house was flooded due to Typhoon Reming;
4. I can no longer locate the said membership despite diligent efforts made, andd is
considered lost for al intent and purposes;
5. I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of July, 2019 at
Legazpi City.

LOLITA I. NARCE
Affiant
ID Account No. 3-607-07-000876
Issued by: Manila Teachers’ Mutual Aid System

SUBSCRIBED AND SWORN to before me this 16th day of July 2019 at Legazpi City,
Philippines. Affiant exhibited herself to me her identification card bearing photograph and
genuine signature as competent proof of her identity pursuant to the 2007 Rules on Notarial
Practice.
Doc. No. 392;
Page No. 80;
Book No. 18;
Series of 2019.