REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.

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AFFIDAVIT OF LOSS

I, TIMOTHY JAMES MYTH J. BALTAZAR, of legal age, single, Filipino and a

resident of Tupax, Jones, Isabela, after having been duly sworn to in accordance
with law, do hereby deposes and states:

1. That I am the holder of a Student License issued by

LTO- Cabarroguis, Quirino on May 3, 2019;

2. That said Student License, was accidentally lost

sometime on the second week of October, 2019 at Santiago City
and despite diligent efforts to locate it, the same could not be found
and beyond recovery;

3. That I am executing this affidavit to attest into the fact of

loss of said Student License and to inform the LTO-Cabarroguis,
Quirino and to request further for the application of a new Student
License.

IN WITNESS WHEREOF, I have hereunto set my hand this 21st day of January,
2020 at Santiago City.

TIMOTHY JAMES MYTH J. BALTAZAR

Affiant

SUBSCRIBED AND SWORN to before me this____day of January, 2020

at Santiago City.

Doc. No.
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Book No.
Series of 2020
REPUBLIC OF THE PHILIPPINES}
SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS

I, JUN JUN SEDICO, of legal age, married, Filipino, and a resident of

Brgy. Gud, San Isidro, Isabela, after having been duly sworn to in accordance
with law, do hereby depose and state:

1. That I am the holder of an OFFICIAL RECEIPT issued by the Land

Transportation Office (LTO), Santiago City;

2. That said OFFICIAL RECEIPT was accidentally lost sometime on

September 2013 at San Isidro, Isabela, and despite diligent efforts to
locate it, the same could not be found and is now beyond recovery;

3. That I am executing this affidavit to attest to the fact of loss of said

OFFICIAL RECEIPT and to inform the LTO-Santiago City and to
request further for the renewal of my Driver’s License even without
the said Official Receipt;

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of

March, 2014 at Santiago City.

JUN JUN P. SEDICO

Affiant

License ID No.B06-086-000317

SUBSCRIBED AND SWORN to before me this 7th day of March, 2014 at

Santiago City.

Doc. No. ____

Page No. ____
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Series of 2014

REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS

I, REYGHIE S. PANTALEON, of legal age, single, Filipino and a

resident of District 4, San Manuel, Isabela, after having been duly sworn to in
accordance with law, do hereby deposes and states:

1. That I am the holder of Permit for Examination issued by AMA

Campus, Santiago City;

2. That said PERMIT was accidentally lost sometime last month of

January, 2013 at Santiago City, and despite diligent efforts to locate
it, the same could not be found and beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of

said PERMIT and to inform the AMA Campus, Santiago City;

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of

February, 2013 at Santiago City.

REYGHIE S. PANTALEON
Affiant

Philhealth ID No. 06-050076335-6

SUBSCRIBED AND SWORN to before me this 1st day of February, 2013

at Santiago City.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2013

REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS
 I, JERRY F. URBANO, of legal age, married, Filipino and a resident of
Barangay Doña Paulina, San Isidro, Isabela, after having been duly sworn to in
accordance with law, do hereby deposes and states:

1. That I am the holder of PROVISIONAL RECEIPT No. 002162 and

002170, issued by Manulife, Santiago City Branch, Santiago City;

2. That said PROVISIONAL RECEIPT was accidentally lost sometime

last month of January, 2013 at Santiago City, and despite diligent
efforts to locate it, the same could not be found and beyond
recovery;

3. That I am executing this affidavit to attest into the fact of loss of

said PROVISIONAL RECEIPT and to inform the Manulife, Santiago
City Branch, Santiago City;

IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of

February, 2013 at Santiago City.

JERRY F. URBANO
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of February, 2013

at Santiago City.

Doc No. _____

Page No. _____
Book No._____
Series of 2013

REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.
x---------------------------------------------x
AFFIDAVIT OF LOSS

I, ANNA FLORABEL N. AYROSO, of legal age, single, Filipino citizen

and a resident of Christine Village, Cauayan City, after having been duly sworn to
in accordance with law, do hereby deposes and states:

1. That I am the holder of SIM CARD No. 09359033158;

2. That said SIM CARD was accidentally lost sometime this month
of January, 2011 at Cauayan City, and despite diligent efforts to
locate it, the same could not be found and beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of

said SIM CARD;

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of

January, 2011 at Santiago City.

ANNA FLORABEL N. AYROSO

Affiant

SSS No. 01-2030309-80

Issued at: Cauayan City

SUBSCRIBED AND SWORN to before me this 28th day of January, 2011

at Santiago City.

Doc No. _____

Page No. _____
Book No.59
Series of 2011

REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.
x---------------------------------------------x
AFFIDAVIT OF LOSS

I, FE DUMALIANG FLORENTIN, of legal age, married, Filipino citizen

and a resident of Barangay Camarag, San Isidro, Isabela, after having been duly
sworn to in accordance with law, do hereby deposes and states:

1. That I am the agent of Manulife Manufacturers Life Insurance,

Branch Office, Santiago City;

2. That said PROVISIONAL RECEIPT was accidentally lost

sometime last month of February, 2011 at Santiago City, and
despite diligent efforts to locate it, the same could not be found and
beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of

said PROVISIONAL RECEIPT and to inform the Manulife Head
Office, Makati City;

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of

May, 2011 at Santiago City.

FE DUMALIANG FLORENTIN
Affiant

Dri. Lic. ID No. B12-09-001720

Issued at: Santiago City
Until: 02-23-12

SUBSCRIBED AND SWORN to before me this 26th day of May, 2011 at

Santiago City.

Doc No. _____

Page No. _____
Book No. _____
Series of 2011

REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS
 I, MARITA M. TUMAMAO, of legal age, married, Filipino and a
resident of Barangay Gomez, San Isidro, Isabela, after having been duly sworn
to in accordance with law, do hereby deposes and states:

1. That I am the holder of PREFARRED SHARES (PS) No. 13755,

issued by Fico Bank, Santiago City Branch, Santiago City;

2. That said PREFARRED SHARES was accidentally lost sometime

last year, 2011 at San Isidro, Isabela, and despite diligent efforts to
locate it, the same could not be found and beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of

said PREFARRED SHARES and to inform the Fico Bank, Santiago
City Branch, Santiago City;

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of

May, 2012 at Santiago City.

MARITA M. TUMAMAO
Affiant

Postal Id No. 9622372

Valid Until: August, 2013

SUBSCRIBED AND SWORN to before me this 30th day of May, 2012 at

Santiago City.

Doc No. _____

Page No. _____
Book No._____
Series of 2012