Republic of the Philippines)

Province of Negros Oriental) S.S.

Municipality of Sibulan . . .)

AFFIDAVIT OF LOSS

I, RUCHEL DINGLASA HOYOHOY, of legal age, Filipino, single,

and a resident of Poblacion, Sibulan, Negros Oriental, Philippines, after
having been duly sworn to in accordance with law, state and declare
that:

1. I was previously issued an Armed Forces and Police Savings

and Loans Association, Inc. (AFPSLAI) passbook with Account No.
61000201197495;

2. I usually place the above-mentioned passbook in one of my

drawers in my office in Taguig City, Metro Manila;

2. Sometime in November 2021, while I was working in Taguig

City, Metro Manila, I noticed that my AFPSLAI passbook was not
anymore in the drawer where I usually place it;

3. I have exerted diligent search and efforts to locate the said

AFPSLAI passbook but the same has not been found or recovered up to
the present such that I now believe that it is now lost beyond recovery.

4. I am executing this Affidavit of Loss to establish the fact of

loss of my AFPSLAI passbook and to attest to the truthfulness and
veracity of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

______________ in Sibulan, Negros Oriental, Philippines.

RUCHEL DINGLASA HOYOHOY

Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public, on this

_______________, for the Municipality of Sibulan and the Province of
Negros Oriental, Philippines, the above-named affiant, who exhibited to
me her Armed Forces of the Philippines Identification Card No. PN-CHR-
00513 valid until June 24, 2024, WHO SIGNED IN MY PRESENCE the
foregoing document (Affidavit of Loss), and who avows under PENALTY
OF LAW to the whole truth of the contents of the same.

Doc No. ____;

Page No.____;
Book No.____;
Series of 2022.

Affidavit of Loss