REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF SAN JUAN ) SS.

PROVINCE OF LA UNION )

AFFIDAVIT OF LOSS

I, MARRON MEICHELLE C. BARIT, 16 years old, student and a resident of

Talogtog, San Juan, La Union after having been duly sworn on oath in accordance
with law hereby voluntarily depose and say:

1. That I was issued my ESP textbook by the San Juan National High School
relative to my studies as Grade 8 student of the same school;

2. That quite by accident, last February 26, 2020 at around 7:00 A.M. the said
book was in my bag and while travelling on jeepney to attend my classes at San
Juan National High School and it was at this juncture that I believe said book fell
off my bag when I took some money from it to pay my fare; that I exerted effort
to locate the same jeepney I rode to look for the book but my efforts turned
futile, thus considered lost and beyond recovery; and

3. That I am executing this affidavit to attest to all the above facts.

IN WITNESS WHEREOF, I have hereunto signed my name below, this 13th day
of March, 2020 at San Juan, La Union, Philippines.

MARRON MEICHELLE C. BARIT

Affiant
LRN: 100854090004, SJNHS

SUBSCRIBED AND SWORN to before me, this 13 day of March, 2020 in San
Juan, La Union and affiant exhibited to me his student ID as stated below his
name and signature above.