REPUBLIC OF THE PHILIPPINES ]

CITY OF TAGBILARAN ] S.S.

AFFIDAVIT OF LOSS

I, REBECCA S. JANGAD, Filipino, of legal age, married and a resident of Ubujan, Tagbilaran
City, Bohol, after being duly sworn to in accordance with law, do hereby depose and say:

1. That I am a public school teacher assigned at Ubujan Elementary School, Tagbilaran City,
Bohol and a member of the Manila Teachers’ Mutual Aid System (MTMAS);

2. That as such, I was issued an MTMAS Passbook and MTMAS Identification Card;

3. That my said MTMAS Passbook and MTMAS Identification Card were misplaced and despite
diligent efforts exerted to find and recover the same, my efforts proved futile as its whereabouts still
could not be ascertained, hence, I considered them to be lost, for all intents and purposes;

4. That my said MTMAS Passbook and MTMAS Identification Card were not transferred to any
person for consideration;

5. That I execute this affidavit voluntarily to attest to the truth of the foregoing statements to
support my request with MTMAS for the issuance of another Passbook and Identification Card in lieu of
the lost one;

6. That I hereby hold free and harmless the said MTMAS for the issuance of another Passbook
and MTMAS Identification Card in my name;

7. That further, I execute this affidavit for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 9 th day of July 2012 at Tagbilaran City,
Bohol, Philippines.

REBECCA S. JANGAD
Affiant

SUBSCRIBED AND SWORN to before me this July 9, 2012 at Tagbilaran City, Bohol,
Philippines, affiant with her DepEd Identification Card with Employee No. 4074547 issued by DepEd –
Bohol.