REPUBLIC OF THE PHILIPPINES]

CITY OF CEBU ] S.S.

AFFIDAVIT OF LOSS

I, , ___________________________, Filipino, of legal age, maried/sigle a

resident of _______ Cebu City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and say that:

1. I am the _________________________ of the University of San

Jose Recoletos, Magallanes Street, Cebu City;

2. I had in my possession the original receipt of Visayan Electric

Company with Official Receipt No. 405649 for the deposit to VECO
for labor, lines & poles And transformer;

3. The said receipt was inadvertently misplaced and despite diligent

efforts exerted the same could not be found. Considering the
sufficient lapse of time, the same is now deemed lost for all intents
and purposes.

4. I am executing this affidavit for the purpose of establishing the

veracity of the foregoing facts in order to facilitate for the refund of
the amount stated in Official Receipt No. 405649 and for whatever
other legal purpose this may best serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of

February, 2007 at the City of Cebu.

_______________________
Affiant

SUBSCRIBED AND SWORN TO before me this ______ day of February,

2021 at the City of Cebu. Affiant exhibiting to me his Passport Number______
issued on January 5, 2007 at Cebu City.

NOTARY PUBLIC

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2007.