Republic of the Philippines)

Province of Negros Oriental) S.S.

CITY OF GUIHULNGAN )
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AFFIDAVIT OF LOSS
(Re: Form 137)

I, CHRISTINE MARIE V. ESPAÑOL, of legal age, married, Filipino,

and a resident of Barangay Poblacion, Guihulngan City, Negros Oriental,
under oath, disclose and aver that:

1. I was a former Grade 7 Adviser of Guihulngan National High

School - Hilaitan, Barangay Hilaitan, Guihulngan City, Negros Oriental;

2. As the adviser, I had in my custody and possession records of

my students such as students’ Form 137 (Students’ Permanent Record)
and other records;

3. Sometime in March 2020, I discovered that the form 137 of my

student, ROGIEMEL ANTIPUESTO CAMBIO with LRN: 120253070007,
was missing;

4. I exerted earnest and diligent efforts to restore and recover said

Form 137, but to no avail, hence I hereby declare it to be lost and
irretrievable for all legal intents and purposes;

5. I am executing this affidavit in order to attest to the truth and

veracity of the foregoing facts and to support my request for the issuance
of another Form 137 of ROGIEMEL ANTIPUESTO CAMBIO from
Calamba Elementary School.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

8th day of May, 2020 in Guihulngan City, Negros Oriental, Philippines.

CHRISTINE MARIE V. ESPAÑOL

Affiant
TIN: 415-395-473-000

SUBSCRIBED AND SWORN to before me this 8th day of May, 2020

in Guihulngan City, Negros Oriental, Philippines.