Republic of the Philippines}

City of Tagbilaran } S.s.

AFFIDAVIT OF LOSS

I, JEMUEL JAY SY MADANGUIT, Filipino, of legal age, and a resident of

Mansasa District, Tagbilaran City, Bohol, Philippines, after having been sworn to in
accordance with law, do hereby depose and state that:

1. I am a holder of a Receipt for payment made to The Supreme

Court in the amount of P3,950 for Fee to Take the 2019 Bar
Examinations. Such receipt was placed in my laptop bag.

2. However, last August 21, 2019, I lost my laptop bag while I was
travelling in Tagbilaran City, and with it, the aforementioned receipt.

3. I tried to obtain and/or recover the said laptop bag from the
proper authorities in the hope that somebody might have surrendered
the same to them but to no avail, my efforts remained futile;

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

foregoing and for whatever legal purpose this may serve.

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

October, 2019 in the City of Tagbilaran, Philippines.

Jemuel Jay Sy Madanguit

Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of October, 2019 in

the City of Tagbilaran, Philippines, the affiant personally known to me.

NOTARY PUBLIC

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