REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S.S.

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AFFIDAVIT

I, FORTUNATO LIM III, of legal age, Filipino, married and a resident of

Blk 15 Lot 3 Phase 2, Buenredro Subdivision, Talisay City, Negros Occidental,
Philippines, after having been duly sworn to in accordance with law hereby
voluntarily depose and say:

1. That I am a holder of JBLCF Training Certificate for Advance Fire Fighting and
PCSRB;

2. That I kept the same in my closet along with my other important documents;

3. That sometime in July 9, 2018 at six in the evening, I discovered that the said
certificate is no longer in my closet;

4. That I exerted all efforts to find and recover said certificate but it could not
be retrieved despite my diligent efforts;

5. That henceforth, I consider the said of JBLCF Training Certificate for Advance
Fire Fighting and PCSRB that was placed inside my closet as lost and beyond
recovery;

6. That I am executing this affidavit to declare that my said of JBLCF Training

Certificate for Advance Fire Fighting and PCSRB as lost and beyond recovery.
This Affidavit attests for any legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of July
2018 at the City of Iloilo, Philippines.

FORTUNATO LIM III

Affiant

JURAT/NOTARIAL CERTIFICATE

The affiant, whose name and personal circumstances are stated above,
personally appeared before me this 16th day of July 2018 in the City of Iloilo,
Philippines, presented the foregoing affidavit, signed the same in my presence
and affirmed under oath to the correctness of the contents or allegations of the
same.

The affiant was identified by competent evidence of identity, namely a

MARINA ID with ID number 7807010009 bearing his photograph and signature.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2018.