Republic of the Philippines)

Province of Cebu )S.S.
Mandaue City )
x---------------x

AFFIDAVIT OF LOSS

I, FELIPE PAGITO A. MANDAL, Filipino, of legal age, married and a resident of

Poblacion, San Remegio, Cebu, Philippines, after being duly sworn in accordance with law,
depose and state:

1. That I am the Project Engineer and I was the one who applied for the installation of the
electrical connection from Cebu II Electric Cooperative Inc. and was issued an Official
Receipt (OR) for the payment of the following schools:

a) Busogon Integrated School with and Official Receipt No. 105288 amounting to
Seven Thousand Five Hundred Fifty Five/29 Pesos (Php7,555.29) Philippine
currency;
b) Lambusan National High School with and Official Receipt No. 105287 amounting to
Seven Thousand Five Hundred Fifty Five/29 Pesos (Php7,555.29) Philippine
currency
c) Anapog Integrated School with and Official Receipt No. 105289 amounting to Six
Thousand Four Hundred Thirty Five/29 Pesos (Php6,435.29) Philippine currency;

2. That the aforementioned Official Receipt (OR) while in my possession was misplaced
and got lost;

3. Efforts were exerted to locate said Official Receipt (OR) , but in spite of diligent search, it
could not be found and the same are now beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing

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

City, Cebu, Philippines.

FELIPE PAGITO A. MANDAL

Affiant

SUBSCRIBED AND SWORN TO before me ______________ in Mandaue City, Cebu,

Philippines, affiant being personally known to me to be the same person who executed the
foregoing instrument.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.