REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ISABELA )
CITY OF ILAGAN ) S.S.
X-------------------------------------------X

AFFIDAVIT OF LOSS

I,______________, a Filipino, of legal age, married and residing at Brgy. Alinguigan

2nd,City of Ilagan, Isabela, Philippines, after having been duly sworn to in accordance with
law do hereby depose and say:

1. That I am the same person executing this affidavit;

2. That I am a holder of Competency Assessment Result Summary (CARS)

(Housekeeping NC II) duly issued by Technical Education and Skills Development
Authority (TESDA), City of Ilagan, Isabela;

3. That, however, said document was inadvertently misplaced;

4. That I exerted all requisite and necessary efforts to locate the same but my efforts
proved futile such that I considered it now as lost for all legal purposes;

5. That said document was not confiscated by any officer of the law or the officers of
TESDA by reason of any violation of any law, ordinance, presidential decree or rules
and regulation of said office;

6. That I am executing this affidavit to attest to the veracity of the foregoing facts and
for whatever purpose that this affidavit may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 27th day of

January 2020 at Calamagui 2nd, City of Ilagan, Isabela.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of January 2020 at City of
Ilagan, Isabela, affiant exhibiting to me his competent evidence of his identity above stated.

Doc. No.
Page No. Notary Public
Book No. 67
Series of 2020