REPUBLIC OF THE PHILIPPINES)

LA TRINIDAD, BENGUET..)s.s

AFFIDAVIT OF LOSS
I, __________________________, of legal age, married, Filipino Citizen and
with residence and postal address at ___________________________, after having
been duly sworn to in accordance with law, do hereby depose and state that:

1. Sometime ________________, I received from the Blessed

Association of Retired Person (BARP) Foundation Inc. a copy of
the Certificate evidencing membership therein of
___________________________.

2. I remember keeping a copy of the said Certificate inside a folder

where I also use to keep other important documents.

3. However, when we needed the said Certificate for some other

transaction, it is no longer inside the folder where I remember to
have kept it. I also looked for it in all other folders and files at home
but could not find it just the same.

4. Because of the foregoing, I am now treating the said Certificate

of Mr. ________________________ as lost and beyond recovery.

5. I am executing this affidavit to attest to the truth of the foregoing

and to support my request for the replacement of the original
copy of the Certificate of ______________________ and for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

__________________________ at _____________________________.

___________________________________
Affiant
ID No.:______________________________
Valid Until:__________________________

SUBSCRIBED AND SWORN TO BEFORE ME this __________________________

at La Trinidad, Benguet. Affiant exhibited to me his/her
_________________________ identification card bearing the above-information
as competent proof of his/ her identity.

Doc. No.________;
Page No. _______;
Book No. _______;
Series of 2023.