REPUBLIC OF THE PHILIPPINES)

Province of Surigao Del Norte) S.S.

City of Surigao)
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AFFIDAVIT OF LOSS

I, EMELITA ALCISO PAQUIRING, Filipino, of legal age, married, and a resident of

Betaugan, Surigao City, after being duly sworn in accordance with law, depose and state THAT:

1 I am the mother of AILYN ALCISO PAQUIRING, female, 13 years old, a First year
high school student of Barangay Taft High School;

2 She was issued by the school textbooks on Araling Panlipunan and Science;

3 On August 21, 2010 in the afternoon, a fire broke out in the place where my daughter
is staying and burned all her things, including the textbooks issued by the school;

4 As all efforts to recover the same proved unrewarding, it is now safe to conclude that
recovery of the same is an impossibility;

5 Thus, I execute this affidavit to establish its loss.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of October 2010 at
Suirgao City, Philippines.

EMELITA ALCISO PAQUIRING

SUBSCRIBED AND SWORN to before me, this 8th day of October 2010, by the Affiant
who exhibited her PHC FED. WOMENS CLUB, INC ID No. 0860.

ATTY. ANDRES D. LORENZO III

PUBLIC ATTORNEY I
RA 9406
Roll of Attorney No. 57433
IBP No. 824760 dated April 22, 2010