REPUBLIC OF THE PHILIPPINES )

PROVINCE OF METRO MANILA) S.S.

CITY/MUNICIPALITY OF PARAÑAQUE)

AFFIDAVIT OF LOSS

I, Mac Jhoven R. Bilaos, Filipino, and residing at #52 Saint Benedict St. Ph-3 Olivarez
Compound, San Dionisio Paranaque City, after having been sworn according to law, hereby
depose and state that:

1. I am the owner of a school Form 138 with student no. 136754100164 issued by
PARAÑAQUE NATIONAL HIGH SCHOOL-MAIN.

2. That I have lost the said Form 138 in the school.

3. That despite diligent search and efforts to locate the Form 138, I could no longer find the same
such that I now believe that it is now lost;

4. As such, I am executing this affidavit of loss to attest to the truth of the foregoing and to
support my application for the issuance of new Form 138 in lieu of the one that was lost.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this ______________at _____________________,

affiant Mac Jhoven Bilaos personally appeared before me and exhibited to me school I.D
136754100164 and is valid until 2023.