REPUBLIC OF THE PHILIPPINES)

CITY OF BACOLOD) SS.

AFFIDAVIT OF LOSS

I, Ms. MARIA MAKISIG, Filipino, of legal age and a resident of Bacolod

City, after being sworn to in accordance with the law, do hereby depose and say:

1. That I am an alumnae of University of Negros Occidental - Recoletos.

2. That as such alumnae, was issued an Identification Card with the student no.
2k4-025056-8 and a claim stub for Diploma and Transcript of Records.

3. That said Identification card and claim stub was in my possession from the time
of issuance but sometime on November 18, 2009 Wednesday or thereabout, the
same was lost and notwithstanding diligent efforts, the same cannot be recovered
or located.

4. That I am executing this affidavit to attest the truth and for whatever legal
purpose it may serve.

_________________
MARIA MAKISIG
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of April 2012 in

Bacolod City, Negros Occidental.

ATTY. JOSE RAFAEL L. SEGOVIA

Notary Public for City of Bacolod
Appointment No. M-74 until December 31, 2019
Roll No. 96720/IBP Lifetime No. 02831
PTR No. 0128138 January 3, 2019
NOTARY PUBLIC

Doc. No. 63432;

Page No. 38742;
Book No. 46534;

Series of 2019;
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD) SS.

AFFIDAVIT OF LOSS

Ako, si Ms. MARIA MAKISIG, Pilipino, ng legal na edad at residente ng Lungsod

ng Bacolod, matapos na isumpa sa alinsunod sa batas, gawin itong magpalabas at
sabihin:

1. Na ako ay isang alumnae ng University of Negros Occidental - Recoletos.

2. Na tulad ng naturang alumnae, ay inisyu ng isang Identification Card kasama ang

mag-aaral na no. 2k4-025056-8 at isang pag-aangkin para sa Diploma at Transcript
of Record.

3. Iyon ang pagkakakilanlan ng Kard ng pagkakakilanlan at pag-aangkin ay nasa

aking pag-aari mula sa oras ng pagpapalabas ngunit sa ibang pagkakataon sa
Nobyembre 18, 2009 Miyerkules o wala pa, ang parehong nawala at sa kabila ng
masigasig na pagsisikap, ang parehong ay hindi mababawi o matatagpuan.

4. Na isinasakatuparan ko ang affidavit na ito upang patunayan ang katotohanan at

para sa anumang ligal na layunin nito na maglingkod.

______________________
MARIA MAKISIG
Affiant

SUBSCRIBED AT SWORN sa harap ko ngayong ika-11 araw ng Abril 2012 sa

Bacolod City, Negros Occidental.

ATTY. JOSE RAFAEL L. SEGOVIA

Notary Public for City of Bacolod
Appointment No. M-74 until December 31, 2019
Roll No. 96720/IBP Lifetime No. 02831
PTR No. 0128138 January 3, 2019
NOTARY PUBLIC

Doc. No. 63432;

Page No. 38742;
Book No. 46534;

Series of 2019;