Republic of the Philippines ))

City of Calbayog )) s.s.

AFFIDAVIT OF LOSS

I, JOHN MICHAEL JALAYAJAY y CENTINO, Filipino, 27 years of age,

single, and presently a resident of P-7, Barangay East Awang, Calbayog City,
Samar, Philippines, after having been duly sworn to in accordance with law,
hereby depose and state, that--

1. I am presently the Head Teacher of Cagbayang Elementary School in

Cagbayang, Calbayog City;

2. As such, I enrolled myself for an Executive Leadership Course for two

(2) Modules in Tacloban City sometime in August 29-30, 2019 and in
September 2019;

3. Anent thereto, I paid for my registration fees in the amount of six

thousand pesos (Php 6, 000.00) per module, for a total of Php
12, 000.00 in which I was issued corresponding receipts for said
payment by the Region Eight Administrators League (REAL), the
organizer of said event;

4. Recently, my wallet where the said receipts were placed was stolen
by still an unidentified person;

5. And despite efforts to locate it, the said receipts cannot be produced,
hence declared lost;

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

facts and for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 4th day of

November 2018, at Calbayog City, Samar, Philippines.

JOHN MICHAEL JALAYAJAY y CENTINO

Affiant
TIN: 440-346-952-000

SUBSCRIBED AND SWORN TO BEFORE ME, this 4th day of November

2018, at Calbayog City, Samar, Philippines.

ATTY. ALJUN B. DIAZ

Public Attorney I
Pursuant to RA 9406