REPUBLIC OF THE PHILIPPINES)

CITY OF ORMOC ) S.S.

x---------------------------------------------x

AFFIDAVIT OF LOSS

I, LUNI TARAY ANDOY, of legal age, Filipino, single, and a resident of Barangay Canadieng,
Ormoc City, Leyte, after having been duly sworn to in accordance with law, depose and
state THAT:

1. I am a graduate of Seafaring Specializing on Stewarding at Ormoc City Institute of

Technology (OCIT);
2. On February 14-26, 2022 I underwent a training course on CROWD CRISIS
MANAGEMENT at Maritime Education Training Center (METC) – University of Cebu
(UC). After completing the course, I receive a CERTIFICATE which is necessary of my
application for apprenticeship;
3. Unfortunately, in November 2022, I brought said certificate together with other
documents to Tacloban to process my Seaman’s Book. Apparently, when I arrived
home, I realize that said certificate is no longer in my folder. I suspect that I must
have accidentally dropped said certificate while I was on my way home;

4. Notwithstanding diligent efforts exerted to find said certificate, the same was not
found, recovered, or located, hence considered lost and destroyed for all intents and
purposes;

5. I am executing this affidavit to attest to the truth of the foregoing facts and for the
purpose of requesting a new copy of Certificate from UC-METC in lieu of the
foregoing item lost and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in Ormoc City,
Leyte, Philippines.

LUNI TARAY ANDOY

Affiant
ID: VOTER’S ID
37380084BC2900LTA10000-3

SUBSCRIBED AND SWORN to me before this _________________________, affiant exhibited to me

his identity card stated above which serves as competent evidence of his identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2023.