REPUBLIC OF THE PHILIPPINES)

CITY OF PASIG )S.S.

AFFIDAVIT OF LOSS

I, ROSALIE TABALOC CAMANO , legal age, married, Filipino, and a resident

of # BLK. 1 MATALINO ST., PUROK 3, LUPANG ARENDA, STA. ANA, TAYTAY RIZAL
after having been duly sworn under oath, hereby depose and say:

1. That I am a holder of CERTIFICATION with number 16-946 issued by

the TAO MANAGEMENT

2. That the said CERTIFICATION with number 16-946 was loss and despite
diligent efforts exerted to locate the same, I could no longer find the
said CERTIFICATION hence considered permanently lost;

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

allegations and for the purpose for securing new CERTIFICATION in lieu
of the lost one.

IN WITNESS HEREOF, I have hereunto set my hand this ______________

2022 at Pasig City.

ROSALIE TABALOC CAMANO

Affiant

SUBSCRIBED AND SWORN to before me this ____________________,

Pasig City.

Doc. No.
Page No.
Book No.
Series of 2022.