Republic of the Philippines )

City of Taguig, Metro Manila) S.S.

AFFIDAVIT OF LOSS

I, RAYMARK C. BERIDA, of legal age, Filipino Citizen, with residence and

postal address at 8 Gervacio St., Zone 6, South Signal Village, Taguig City, Metro
Manila, after having duly sworn to in accordance with law do hereby depose and
state:

That I am the father of CHLOE MAE TONICO who was born on January 23,
2013 at Taguig-Pateros District Hospital and as such a holder of my daughter’s
Certificate of Live Birth issued by the said hospital;

That on August 15, 2015, while our family was transferring to our new
residence, the aforesaid Certificate of Live Birth which was placed in one of the
cabinets being transferred was lost, probably misplaced;

That I exerted all efforts to locate or find the said Certificate of Live Birth, but
proved futile and meaningless whatsoever;

That I am executing this AFFIDAVIT to attest to the truth and veracity of the
above statements for all LEGAL INTENTS and PURPOSES it may serve best.

IN WITNESS HEREOF, I have hereunto signed my name this 2 nd day of May

2016 at City of Taguig, Metro Manila.

RAYMARK C. BERIDA
Affiant

SUBSCRIBED & SWORN TO BEFORE ME this 2 nd day of May 2016 at City

of Taguig, Metro Manila, affiant exhibiting to me his Driver’s License No. N03-15-
009274 valid until 2018-03-23.

ATTY. VOLTAIRE BAN L. DELOS

REYES
Doc. No. 278. Notary Public
Page No. 57. Cities of Taguig, Pasig, San Juan and Pateros
Book No. VI. Commission Appointment No. 80(2015-2016)
Series of 2016. Until December 31, 2016/ MCLE NO. IV-0018532
IBP Lifetime Member No. 013905; Cavite / Roll No. 61669
PTR No. A-2601004;1-05-2016; Taguig City
B25 L39, Upper Bicutan, Taguig City