REPUBLIC OF THE PHILIPPINES)

CITY OF ______________ ) S.S

AFFIDAVIT OF LOSS
I, ______________________________, of legal age, Filipino citizen and a
resident of ____________________________________after having been dully sworn
to in accordance with law depose and say;

1. That I am the holder and rightful owner of an original copy of

Certificate of Completion issued by World Safety Organization;

2. That the said original copy of Certificate of Completion was

lost/misplaced;

3. That despite diligent effort to locate the said original copy of

Certificate of Completion, but the same could no longer be found;

4. That I am executing this affidavit to attest to the truth of the foregoing

facts and for whatever legal intents and purpose this may serve.

AFFIANT SAYETH NAUGHT.

____________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ____________________ at

__________________________, by __________________________________who has
satisfactorily proven his/her competent evidence of identity through his/her
________________________, that he/she is the same person who personally signed
before me the foregoing Affidavit and acknowledged that she executed the same.

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