REPUBLIC OF THE PHILIPPINES)

CITY OF BACOLOD ) S.S.

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

AFFIDAVIT OF LOSS

I, GWENDOLYN A. LAUD, of legal age, Filipino, married and a resident of Purok

Paglaum, Brgy. 17, Bacolod City, after having been duly sworn to in accordance with law, depose
and state that:

1. That I am the mother of Gerlaine Althea A. Laud;

2. That my daughter is a Grade IV pupil of Mabini Elementary School, Bacolod City, School
Year 2017-2018;

3. That my daughter was given the following books to be returned to the school at the end pf
the school year 2017-2018 to wit:

a) English Learner’s Material – by Grace U. Rolsela, Victoria D. Mangaser, Lilibeth

A. Magalang, Rose Ann B. Pamimtuan;

b) Edukasyong Pantahanan at Pangkabuhayan – mga manunulat Entrepreneur & ICT

Eden F. Sanada, Marilou F. Salagun, Virgilio L. Lagua, Marilou E., Marta R.
Benisano;

c) Edukasyong Pangkatauan at Kalusugan – Mila C. Tano, Maria Teresita Garcia

Aguilar, Juny B. Nitura Ed D, Maria Fe Estilloso

d) Musika at Sining – Cynthia Montanez, Ma. Teresa Caringal, Adulfo Amit

e) Yaman ng Lahi – Sancho C. Calatrava, Modista R. Jaurique, Fraglyn B. Rafael

4. That I exerted diligent efforts in searching for the missing Books but my efforts were in
vain. Hence, said Books are considered lost for all legal intents and purposes;

5. That I am executing this affidavit to attest to the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________ at

Bacolod City, Philippines.

GWENDOLYN A. LAUD
Affiant

SUBCRIBED AND SWORN TO before me this ______________ at Bacolod City,

Philippines, affiant exhibiting to me her COMELEC VIN No. 4501-0151A-H2268GAL20000-6
as competent proof of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S.
x-------------------------------------x

AFFIDAVIT OF LOSS

I, ALEX S. CASTOR of legal age, Filipino, married and a resident of Brgy. Efegenio
Lizares, Talisay City, Negros Occidental, after having been duly sworn to in accordance with law,
depose and state that:

6. That I am a holder of GREEN PASSBOOK with member number 026290 issued by

Philippine Army Finance Center Producers Integrated Cooperative (PAFCPIC);

7. That the said GREEN PASSBOOK lost or misplaced;

8. That I exerted diligent efforts in searching for the missing GREEN PASSBOOK but my
efforts were in vain. Hence, said Passbook is considered lost for all legal intents and
purposes;

9. That I am executing this affidavit to attest to the foregoing facts and for any legal purpose
it may serve and to request a new BIR TIN I.D in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________ at

Bacolod City, Philippines.

ALEX S. CASTOR
Affiant

SUBCRIBED AND SWORN TO before me this ______________ at Bacolod City,

Philippines, affiant exhibiting to me his PAFCPIC I.D No. 26290 valid until 02/15/2020 as
competent proof of identification.

Doc. No. _____;

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

REPUBLIC OF THE PHILIPPINES)

CITY OF BACOLOD ) S.S.
x-------------------------------------x

AFFIDAVIT OF LOSS

I, REYMART DURAN of legal age, Filipino, single and a resident of Bacolod City, Negros
Occidental, after having been duly sworn to in accordance with law, depose and state that:
 10. That I am a holder of BIR TIN I.D issued by Bureau of Internal Revenue;

11. That the said BIR TIN I.D lost or misplaced;

12. That I exerted diligent efforts in searching for the missing BIR TIN I.D but my efforts were
in vain. Hence, said ID are considered lost for all legal intents and purposes;

13. That I am executing this affidavit to attest to the foregoing facts and for any legal purpose
it may serve and to request a new BIR TIN I.D in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________ at

Bacolod City, Philippines.

REYMART DURAN
Affiant

SUBCRIBED AND SWORN TO before me this ______________ at Bacolod City,

Philippines, affiant exhibiting to me his _______________________ as competent proof of
identification.

Doc. No. _____;

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