Republic of the Philippines . . . . .

)
City of Victorias . . . . . . . . . . . . . . ) Sc.
x - - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, JOY G. ESCLARES, of legal age, Filipino, married, and a resident of

Quezon Street, Brgy. IV, Victorias City, Negros Occidental after having been
duly sworn to in accordance with law hereby depose and state that:

1. I am a holder of a passbook issued by the Manila

Teachers Mutual Aid System (MTMAS);

2. Last January 1, 2021, I discovered that the said

passbook is missing;

3. For over a year now, I exerted diligent efforts to locate

said passbook but to no avail and I therefore considered the same
as lost and can no longer be found;

4. I am executing this Affidavit to attest to the truth of

the foregoing facts and to use the same for whatever legal purpose
it may serve.

IN TRUTH AND WITNESS WHEREOF, I hereby set my hand this ____ th

day of August, 2022 in Victorias City, Philippines.

___________________________
JOY G. ESCLARES
Affiant
Voter’s Identification No. 4531-0030A-G0760JGE20000

SUBSCRIBED AND SWORN TO BEFORE ME, this ______ th day of August

2022 in Victorias City, affiant personally appeared and showed a competent
evidence of her identity: Voter’s Identification No. 4531-0030A-
G0760JGE20000 issued by the Commission on Elections- Victorias City
(Comelec), personally signed the foregoing instrument before me and vowed
under penalty of law to the whole truth of the contents of the said instrument.

WITNESS MY HAND AND SEAL.

Doc No. _____;

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