Republic of the Philippines)

City of Dumaguete ) S.S.

AFFIDAVIT OF LOSS
I, MARICEL FURTON OROLA, of legal age, widowed, Filipino and a resident of
Basak, San Jose, Negros Oriental, after having been duly sworn to in accordance with law, do
hereby depose and state THAT:
1. I am the MOTHER of the minor, GIEMAR O. FURTON, a Grade 8 student of Aquino
National Highschool, located at San Jose, Negros Oriental;

2. That he was a holder of a SCIENCE book which was issued to him and his classmate by
their Grade 8 teacher;

3. Sometime in March, 2020, they had their Periodical Exam in Science and were ordered to
put all their books in front to avoid cheating;

4. After their exam, Giemar lost ahold of the book and could not find it anymore such that it
was his honest belief that the Science book must have been mistakenly held by his other
classmates;

5. Earnest efforts were made to locate the said Science book, but to no avail, such that we
now believe that the said Science book is now lost and is already beyond recovery;

6. I am executing this Affidavit to attest to the truth of the foregoing and for whatever legal
purposes this may serve best.
IN WITNESS WHEREOF, I have hereunto set my hand this 9 th day of September, 2020,
in Dumaguete City.

MARICEL FURTON OROLA

Affiant
Proof of Identity: COMELEC I.D
I.D.No.: VIN: 4617-0008A-
K0277MOF20000

SUBSRIBED AND SWORN TO BEFORE ME, this 9th day of September, 2020, in
Dumaguete City.

Doc No.:
Page No.:
Book No.:
Series of 2020.