REPUBLIC OF THE 

PHILIPPINES)
CITY OF DUMAGUETE                 ) S.S.

  
AFFIDAVIT OF LOSS 

I, YUSHMAD CANIZARES, of legal age, Filipino, married and a resident of

Bacong, after having been duly sworn to in accordance with law, depose
and state:
1. That I am a holder of a National Certificate II in Security Services;

2. That it was issued by the Technical Education and Skills

Development Authority;

3. That said Certificate was missing and must have been lost
sometime in February 1, 2023 when there was a renovation of our
residential house.

4. That despite diligent search and efforts to locate said, I could not
find it;

5. That I am executing this affidavit to attest to the foregoing facts

and to request for a replacement of the above mentioned Certificate.

         IN WITNESS WHEREOF, I have hereunto set my hand

this _____________________ in Dumaguete City, Negros Oriental, Philippines.
          

YUSHMAD CANIZARES
Affiant
LTO ID No.

    SUBCRIBED AND SWORN TO before me this _________________

in Dumaguete City, Negros Oriental, Philippines, affiant exhibiting to me his
valid proof of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2023.