Republic of the Philippines)

DONE: CITY OF BAGUIO) SS.

AFFIDAVIT OF LOSS
I, ZALDY DIONESIO MAGANSAY, married, of legal age, Filipino Citizen, with
residence and postal address at Purok 2, Lublub, Alfonso Castañeda, Nueva Vizcaya,
Philippines, after having been duly sworn to in accordance with law do hereby deposes and
states, that:

1. I am a retired Public School Teacher and a member of the Philippine Public School
Teachers Association, Inc.;

2. For being a member of the aforesaid association, I was issued a Mutual Retirement
Benefit System (MRBS) Policy which I kept in my files;

3. When I needed the said Policy, I tried to find it, however, I failed. I am not sure how
it was lost, maybe it was misplaced. For how many times that I and my family
transferred our residence and maybe one of those transfer, my MRBS Policy was
misplaced or accidentally thrown away;

4. I exerted diligent efforts to locate my MRBS POLICY but to no avail, hence,

considered forever lost;

5. The said MRBS POLICY has not been given nor pledged to anyone for any purpose
whatsoever, nor was it taken nor confiscated by the authorities;

6. I am executing this affidavit to attest to the truth of my foregoing statements and to

secure new MRBS POLICY in lieu of the lost one, and for all legal intents and
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of May, 2023, at
Baguio City, Philippines.

ZALDY DIONESIO MAGANSAY

AFFIANT
National ID No. 5630-6158-4290-7180

SUBSCRIBED AND SWORN TO before me this 24th day of May, 2023, at Baguio City,
Philippines. Affiant personally appeared and to be the same person who executed this instrument
as his free act and deed.

Doc. No. ____________;
Page No. ____________;
Book No. 67;
Series of 2023.
MODESTO T. ANDONG
Notary Public
Comm. N.A.-56-NC-22-R until Dec. 31, 2024
PTR No. 4902764/1-04-2023
IBP OR No. 271717/1-5-2023
ROLL No. 31289/5-15-81/Manila
BIR TIN No. 121-017-652-000
MCLE Comp. No. VII-0025907/Valid Until: April 14, 2025
ANDONG and NEBATEN LAW OFFICE
No. 19 2nd flr., Old Market Building,
Upper Magsaysay Ave., Baguio City, 2600