REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, DINA GADDI ATIENZA, of legal age, Filipino, with address at 415
Luksuhin Ibaba, Alfonso Cavite after having been sworn to in accordance with law,
hereby depose and state, that:

1. I am a teacher and a member of the Philippine Public School

Teacher Association(PPSTA);

2. I applied for New Mutual Retirement Benefit System (NMRBS)

Early Redemption Program (ERP) and one of the requirements is
the original copy of the New Mutual Retirement Benefit System
(NMRBS) Certificate of Membership, however, my said certificate
was lost. I misplaced it in our house;

3. I exerted diligent effort to find the said New Mutual Retirement

Benefit System (NMRBS) Certificate of Membership but the same
could no longer be found; hence, considered forever lost;

4. Said New Mutual Retirement Benefit System (NMRBS) Certificate

of Membership was not taken or confiscated by the authorities for
any violation of the law

5. I am executing this affidavit to attest to the veracity and

truthfulness of my foregoing statements and to support my
application for New Mutual Retirement Benefit System (NMRBS)
Early Redemption Program (ERP) and for other lawful intents and
purposes it may serve

IN TRUTH WHEREOF, I have hereunto affixed my signature this 15 th day of

April, 2019 at Alfonso, Cavite.

DINA GADDI ATIENZA

Affiant

SUBSCRIBED AND SWORN to before me this 15 th day of April 2019 at

Alfonso, Cavite. Affiant exhibiting to me her PRC ID no. 0141084 exp. 05/20/2021.

WITNESS MY HAND AND SEAL.

Doc. No. 174;

Page No. 36;
Book No. LXX;
Series of 2019.