REPUBLIC OF THE PHILIPPINES )

City of Manila ) S.S.

x-------------------------x

AFFIDAVIT OF LOSS

I, ARABELLA M. FRONDA, Filipino, 17 years of age, single and a resident of 2504-B

Callejon 5, del Pilar, Brgy. 882, Sta. Ana, Manila, Philippines, after being duly sworn to in
accordance with law, hereby depose and state that:

1. In April 2019, I scanned my Form 138 for making my Career Portfolio;

2. That recently, I’m applying for admission at De La Salle-College of St. Benilde and
one of the requirements is to provide the original copy of my Form 138;

3. On the same day, I looked for my Form 138 but to no avail. Said Form 138, that despite
diligent search and efforts to locate the said Form 138, I could not find it such that I
now believe that it is now lost beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing, to
support my application for college admission and for whatever legal purpose that this
Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 3rd day of October, 2019 at
Manila, Philippines.

ARABELLA M. FRONDA
AFFIANT

SUBSCRIBED AND SWORN to before me, this 3rd day of October, 2019, by the Affiant
who is personally known to me (or whom I have identified through competent evidence of identity)
and who exhibited her School Identification Card No. 2018100010 issued at Manila, Philippines.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2019.