Republic of the Philippines)

Province of Negros Oriental) S.S.

Municipality of Sibulan . . .)

AFFIDAVIT OF LOSS

I, FLORENCE GRAMPON ENTAC, of legal age, single, Filipino and a

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

1. I was in possession of the Certificate of Marriage of my mother

GRACIANA GRAMPON ENTAC which was issued by the Local Civil Registrar of
Jolo, Sulu;

2. That the said Certificate of Marriage while in my possession was burned

during a fire in our residence in Jolo, Sulu;

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

Certificate of Marriage of my mother GRACIANA GRAMPON ENTAC 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.

FLORENCE GRAMPON ENTAC

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 National ID No. 4932-
9689-7406-9017, 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