AFFIDAVIT OF LOSS

I, GILBERTO Q. MADERSE JR., of legal age, married, Filipino citizen, and with residence
and postal address at 70 Cotabato St. Bago Bantay Quezon City, after having been duly sworn in
accordance with law do herby depose and state:

1. That I am a holder of a Certificate of Proficiency in Fast Rescue Boat issued by the Far
East Maritime Training Center;

2. That I have lost my said Certificate of Proficiency in Fast Rescue Boat and despite
diligent research, the same remains missing to this day;

3. That under the circumstances , my said Certificate of Proficiency in Fast Rescue Boat can
no longer be found, hence, may now be considered lost for all legal intents and purposes;

4. That I am executing this affidavit to attest the truth of the foregoing statements and for
the purpose of reprinting of the said Certificate of Proficiency in Fast Rescue Boat.

IN WITNESS WHEREOF, I have hereunto set my hand this 22th day of September, 2019 at
Quezon City, Philippines.

GILBERTO Q. MADERSE JR.

Affiant

________________________
(I.D. presented)

SUBSCRIBED AND SWORN TO, before me this 22th day of September 2019 at Quezon City,
Philippines.