REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, CAROLYN FAYTAREN ASEBUCHE, of legal age, Filipino, with
address at Bilog, Alfonso Cavite after having been sworn to in accordance with law,
hereby depose and state, that:

1. I am in possession of a Claim Stub issued by BFP-Alfonso Cavite

under the name of Josemaria Paolo C. Icasas;

2. However, upon checking my files, I found out just recently that the
said Claim Stub was misplaced and cannot be found;

3. Despite diligent search and efforts to recover the said Claim Stub
the same can no longer be located;

4. I am executing this affidavit not for any unlawful purpose but for
any valid and legal purpose only.

IN TRUTH WHEREOF, I have hereunto affixed my signature this 17 th day of

March, 2023 at Alfonso, Cavite.

CAROLYN FAYTAREN ASEBUCHE

Affiant

SUBSCRIBED AND SWORN to before me this 17th day of March, 2023 at

Alfonso, Cavite. Affiant exhibiting to me her TIN:740-561-013-000.

WITNESS MY HAND AND SEAL.

Doc. No. 115;

ATTY. ENRIQUE G. BAUTISTA JR.
Page No. 24; NOTARY PUBLIC FOR THE PROVINCE OF CAVITE
Book No. 5; COMMISSION EXPIRES ON DECEMBER 31, 2024
ROLL OF ATTORNEY’S NO.52758
Series of 2023. PTR NO. 5842958/ISSUED ON 01/9/2023 AT ALFONSO CAVITE
IBP LIFETIME No. 031665/01/30/2018
MCLE COMPLIANCE VII-0012699 VALID UNTIL APRIL 14, 2025