REPUBLIC OF THE PHILIPPINES)

) S.S.

AFFIDAVIT OF LOSS

That I, JOHN LOUIE S. AMIGO, of legal age, Filipino Citizen, and with address at
D-40 TESTA COMPOUND SUMULONG HIGHWAY MAYAMOT ANTIPOLO CITY, after
having been duly sworn to in accordance with law do hereby depose and say:

That I am the holder of Good Moral Certificate and Card (FOURTH

SEMESTER) issued by: OLOPSC

That sometime on April 21, 2019 the said Good Moral Certificate and Crad
(FOURTH SEMESTER) was lost, due to unexpected circumstances;

That diligent effort was exerted to locate the same but it yielded a negative result:

That I am executing this affidavit of loss to attest the truth of the foregoing facts and
for reporting/for replacement/ and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____________________________, ______________________, Philippines

JOHN LOUIE S. AMIGO

Affiant

SUBSCRIBED AND SWORN to before me this___________________ affiant

exhibiting to me his/ her CTC No. __________________ issued on ______________ at
_____________ Philippines.

Doc No. ________

Page No. ________
Book No. ________ Notary public
Series of 2019