Republic of the Philippines

City of Butuan

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, ALFREDO L. BALUYUT, JR., of legal age, Filipino, married, and

a resident of 126 T. Calo Extension, Butuan City, after having been sworn
in accordance with law, hereby depose and state the following:

1. That on April 06, 2022, I was issued a Certificate of Registration as

a Real Estate Broker, by the Department of Home Settlement and
Urban Development (DHSUD);

2. As a requirement for the said Certificate, I paid the amount of

Seven Hundred Twenty Pesos (₱ 720.00) as Registration Fee and
One Thousand Pesos (₱ 5,000.00) as Cash Bond covered by official
receipt No. 4184624 on April 05, 2022. These data are reflected in
the said certificate;

3. That for the renewal of the year 2023, DHSUD required the
presentation of the old official receipt mentioned above but despite
my diligent search, I cannot find the said document;

4. That I am executing this affidavit to attest to the truthfulness of the

facts stated herein.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day

of March 2023 at Butuan City, Philippines.

ALFREDO L. BALUYUT, JR.

Affiant

SUBSCRIBED AND SWORN TO before me this _______ day of March

2023, affiant exhibiting his Community Tax Certificate No.
_______________________ issued on ____________________, 202__
at Butuan City, Philippines.

Doc: ______________________
Book: ______________________
Page No. ______________________
Series of 2023.