REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ISABELA )
CITY OF CAUAYAN ) S.S

AFFIDAVIT OF LOSS

I, EDNAMER S. CADA, of legal age, Filipino, married, and a resident of Brgy.

Magsaysay, Naguilian, Isabela and an employee of PCSO NCL Isabela Branch Office,
Cauayan City, after having been duly sworn to in accordance with law hereby depose
and state that:
1. I am the Cashier IV of PCSO Isabela Branch, Cauayan City.
2. The Original Job Order Payroll with the amount of Five Thousand One
Hundred Pesos (P5,100) for the period of May 1 – 31, 2018 is supposed to be
transmitted to PCSO Head Office as an attachment to the approved Original
Voucher of the said payroll.
3. Said Original Job Order Payroll was lost sometime on the first week of
September 2018.
4. I made diligent search to recover the said Original Job Order Payroll, but it
was nowhere to be found despite earnest effort.
5. For all legal intents and purposes the said Original Job Order Payroll is now
considered lost and beyond recovery;
6. I am submitting a photocopy of the Original Job Order Payroll as a reference
and substitute to the lost document.
7. I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purposes it may serve.
8. I am executing this affidavit to request the PCSO Department concerned, to
acknowledge the certified true Xeroxed Copies of the Original Job Order
Payroll.

FURTHER AFFIANT SAYETH NAUGHT.

IN TRUTH THEREOF, I have hereunto signed my name below, this 11th day of

September, 2018, at Cauayan City, Isabela, Philippines.

EDNAMER S. CADA
Affiant

SUBSCRIBED AND SWORN to before me this 11th day September, 2018 by

EDNAMER S. CADA, who exhibited to me her valid PCSO ID No. 19940697.

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REPUBLIC OF THE PHILIPPINES )
PROVINCE OF PANGASINAN )
CITY OF URDANETA )

AFFIDAVIT OF LOSS

I, YAMASHITA B. JAPINAN, of legal age Filipino, married, and a resident of

Brgy. Magsaysay, Naguilian, Isabela and an employee of PCSO Pangasinan Branch

Office, Urdaneta City, after having sworn to in accordance with law hereby depose and

say:

1. That I am the OIC Branch Manager of PCSO Pangasinan Branch Urdaneta City.

2. That the original Original Disbursement Voucher received by Agustin Castro,

withdrawn Lotto Agent, evidencing receipt of Installation fee refund of

P10,000.00 with Check#2397749 dated 28-Jan-15, was detached when

transmitted to PCSO Head Office, although it was indicated on the transmittal

letter.

3. I have been notified and only the Acknowledgment Receipt was received.

4. I took pains to look for the original Disbursement Voucher, but it was nowhere to

be found despite earnest effort.

5. I am submitting the Xeroxed copies of the Disbursement voucher but with

original signature of the Claimant, Mr. Agustin Castro.

6. That I am executing the affidavit to attest to all the above facts, and to request the

PCSO Department concerned to acknowledge the certified true Xeroxed copies

for the Disbursement Voucher of the withdrawn Lotto Agent for refund.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 29th day of

June, 2015.

_YAMASHITA B. JAPINAN
Affiant
 SUBSCRIBED AND SWORN to before me this 29th day June, 2015 by
YAMASHITA B. JAPINAN, who exhibited to me her PCSO ID No. 19910595 valid
until 2016.

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Series of 2015

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PANGASINAN )
CITY OF URDANETA )

AFFIDAVIT OF LOSS

I, MINDA G. PERALTA, of legal age Filipino, married, and a resident of

Balungao, Pangasinan after having sworn to in accordance with law hereby depose and

say:

1. I am the Vice-Mayor of the Municipality of Balungao.

2. That I am a former Lotto Agent of PCSO Pangasinan Branch Urdaneta City with

Agency Number 34-0491-9.

3. That the original Original Official Receipt #754835, dated 5/07/2012,

evidencing payment for Cash Bond of P300,000.00 was misplaced.

4. That we took pains to look for the original official receipt, but it was nowhere to

be found despite our earnest effort.

5. That I am executing the affidavit to attest to all the above facts, and to request the

PCSO to acknowledge the certified true Xeroxed copies for the request of refund

of Cash Bond.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 22nd day of

October, 2014.

_ MINDA G. PERALTA
Affiant

SUBSCRIBED AND SWORN to before me this 22nd day October, 2014 by

MINDA G. PERALTA, who exhibited to me her BIR TIN ID No. 927-260-462.
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‘;L;;;

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PANGASINAN )
CITY OF URDANETA )

AFFIDAVIT OF LOSS

I, MINDA G. PERALTA, of legal age Filipino, married, and a resident of

Balungao, Pangasinan after having sworn to in accordance with law hereby depose and

say:

7. That I am a former Lotto Agent of PCSO Pangasinan Branch Urdaneta City, with

Agency Number 34-0491-9.

8. That I voluntary terminate my Agency Agreement with PCSO and requesting for

the refund of my Cash Bond of P300,000.00.

9. That the original Original Official Receipt #754835, dated 5/07/2012,

evidencing payment for Cash Bond of P300,000.00 of Minda Peralta, Lotto

Agent.

10. That we took pains to look for the original official, but it was nowhere to be

found despite our earnest effort.

11. That I am executing the affidavit to attest to all the above facts, and to request the

PCSO Department concerned to acknowledge the certified true Xeroxed copies

for the request of for refund.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 5th day of

November, 2014.

_ MINDA G. PERALTA
Affiant
 SUBSCRIBED AND SWORN to before me this 5th day October, 2014 by
MINDA G. PERALT who exhibited to me her PCSO ID No. 19910595 valid until
2016.

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Page No. _________
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Series of 2014

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PANGASINAN )
CITY OF URDANETA )

AFFIDAVIT OF LOSS

I, MINDA G. PERALTA, of legal age Filipino, married, and a resident of

Balungao, Pangasinan after having sworn to in accordance with law hereby depose and

say:

6. I am the Vice-Mayor of the Municipality of Balungao.

7. That I am a former Lotto Agent of PCSO Pangasinan Branch Urdaneta City.

8. That the original Original Official Receipt #7549840, dated 8/06/2012,

evidencing payment for Cash Bond of P300,000.00 of ROLAND O. ROSARIO,

Lotto Agent.

9. That we took pains to look for the original official, but it was nowhere to be

found despite our earnest effort.

10. That I am executing the affidavit to attest to all the above facts, and to request the

PCSO to acknowledge the certified true Xeroxed copies for the request of for

refund of Cash Bond.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 22nd day of

October, 2014.

_YAMASHITA B. JAPINAN
Affiant
 SUBSCRIBED AND SWORN to before me this 22nd day October, 2014 by
YAMASHITA B. JAPINAN, who exhibited to me her PCSO ID No. 19910595 valid
until 2016.

Doc. No.__________
Page No. _________
Book No. _________
Series of 2014

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PANGASINAN )
CITY OF URDANETA )

AFFIDAVIT OF LOSS

I, YAMASHITA B. JAPINAN, of legal age Filipino, married, and a resident of

Brgy. Magsaysay, Naguilian, Isabela and an employee of PCSO Pangasinan Branch

Office, Urdaneta City, after having sworn to in accordance with law hereby depose and

say:

12. That I am the OIC Branch Manager of PCSO Pangasinan Branch Urdaneta City.

13. That the original Original Disbursement Voucher received by Agustin Castro,

evidencing receipt of Installation fee refund of P10,000.00 with

Check#2397749 dated 28-Jan-15, was detached when transmitted to PCso

Head Office.That we took pains to look for the original official, but it was

nowhere to be found despite our earnest effort.

14. That I am executing the affidavit to attest to all the above facts, and to request the

PCSO Department concerned to acknowledge the certified true Xeroxed copies

for the request of the terminated agent for refund.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 22nd day of

October, 2014.

_YAMASHITA B. JAPINAN
 Affiant

SUBSCRIBED AND SWORN to before me this 22nd day October, 2014 by

YAMASHITA B. JAPINAN, who exhibited to me her PCSO ID No. 19910595 valid
until 2016.

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Series of 2014

AFFIDAVIT OF LOSS

I, ANTHONY A. CADA, of legal age Filipino, married, and a resident of Purok

Raniag, Brgy. Magsaysay, Naguilian, Isabela and an employee of PCSO Isabela Branch,

Cauayan City, Isabela, after having sworn to in accordance with law hereby depose and

say:

1. That I am the Acting Supply Officer of PCSO Isabela Branch, Cauayan City.

2. That the following Prize Claim Forms were missing under my custody:
090201-091200 = 10 pads
296001-296100 = 1 pad
296200 = 1 set

3. That when the COA Auditor conducted inventory the subject Prize Claim Forms

cannot be presented.

4. That these forms were erroneously issued to our Lotto Agents as Agents

Settlement Forms because one Agent returned the pad with series 296101-199.

5. That we took pains to look for the above forms and conducted queries with our

Lotto Agents, but they were no where to be found.

6. That I am executing the affidavit to attest to all the above facts.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 12th day

of March 2013.

_ ANTHONY A. CADA
Affiant
 SUBSCRIBED AND SWORN to before me this 12th day of March, 2013 by

ANTHONY A. CADA who exhibited to me his Residence Certificate No.

2011-31807793, dated 1/7/2013, at Naguilian, Isabela.

NOTARY PUBLIC

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ISABELA )
CITY OF CAUAYAN )

AFFIDAVIT OF LOSS

I, YAMASHITA B. JAPINAN, of legal age Filipino, married, and a resident of

Brgy. Magsaysay, Naguilian, Isabela and an employee of PCSO Isabela Provincial

District Office, Cauayan City, Isabela, after having sworn to in accordance with law

hereby depose and say:

15. That I am the Chief Lottery Operations Officer of PCSO Isabela Provincial

District Office, Cauayan City.

16. That the original Disbursement Voucher #0704003193, with Original Official

Receipts # 0070 dated 5/25/2008, evidencing payment to DR. RODOLFO

FERNANDEZ, representing financial assistance for chemodrugs to patient

ANALYN SISON per feedback report #07-01=0356 in the amount of P20,

000.00, was allegedly returned to the Branch for completion of charged slips.

17. That when the subject official documents were returned to Head Office- Treasury

Department stated that only Xeroxed copies were sent.

 18. That we took pains to look for the original documents, but they were no where to

be found.

19. That I am executing the affidavit to attest to all the above facts, and to request the

PCSO Department concerned to acknowledge the certified true Xeroxed copies.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 15th day of

October, 2008.

_YAMASHITA B. JAPINAN
Affiant

SUBSCRIBED AND SWORN to before me this 15th day October, 2008 by

YAMASHITA B. JAPINAN, who exhibited to me his Residence Certificate No.

CC!#08676402, dated 1/22/2008 , at Naguilian, Isabela.

NOTARY PUBLIC

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ISABELA )
CITY OF CAUAYAN )

AFFIDAVIT OF LOSS

I, PEPE HABIATAN, JR, of legal age Filipino, married, and a resident

Munggayang, Kiangan, Ifugao after having sworn to in accordance with law hereby

depose and say:

20. That I am farmer of Kiangan, Ifugao.

21. I am a winner of five digits 6/42, so I traveled to PCSO Provincial District

Office Cauayan City to claim for it.

22. That when I hand over the supporting receipts to the Cashier, the pay receipt

handed by the teller was not among them.

 23. That I took pains to look for it, but it was no where to be found.

24. That I am executing the affidavit to attest to all the above facts, and to request the

PCSO office concerned to pay my winning ticket.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 2nd day of

January, 2008.

_PEPE HABIATAN, JR.

Affiant

SUBSCRIBED AND SWORN to before me this 2nd day January, 2008 by

PEPE HABIATAN, JR, who exhibited to me his Residence Certificate No.

086470000, at Cauayan City, Isabela.

NOTARY PUBLIC