REPUBLIC OF THE PHILLIPPINES

Province of Surigao del Sur

Municipality of Cantilan

AFFIDAVIT OF LOSS

I, CHARLIE JOY G. INTANO, of legal age, Filipino Citizen, with residence and postal address at P-
6, Pag-antayan, Cantilan, Surigao del Sur, after having sworn to in accordance with law do hereby depose
and state:

1. That I received the MEMORANDUM FOR PERMANENT APPOINTMENT (NEWLY HIRED)

DOCUMENT, issued by the Schools Division of Surigao del Sur.

2. That recently last December 20, 2019 (Friday), while I was at the Schools Division Office to
comply the requirements for permanent appointment for evaluation and checking. However, on the same
day, after arriving home, unfortunate turn of event happened that the original copy of the MEMORANDUM
FOR PERMANENT APPOINTMENT (NEWLY HIRED) DOCUMENT was already missing as it might
accidentally fell-off from the folder I was carrying or misplaced it somewhere.

3. That despite diligent search and effort, the said document is nowhere to be found and now lost
beyond recovery.

4. That this affidavit was executed to attest the truth of the foregoing and for purpose of the re-
issuance of the aforementioned missing document in my favor and whatever legal purpose it may serve
best.

AFFIANT FURTHER SAYETH NAUGHT.

CHARLIE JOY G. INTANO

Affiant

SUBSCRIBED AND SWORN to before me this _______ day of ______________ at

_____________, Surigao del Sur, affiant exhibiting to me his PRC ID No. 1681114, issued at PRC Davao
City.

NOTARY PUBLIC