1

Republic of the Philippines)

) S.S.
Done: in the City of Baguio)

AFFIDAVIT OF LOSS

I, MEDARDO DELIZO FERRERA, of legal age, married, Filipino

citizen, and with residence at No. 3, Bagulin Road, Gusing Sur,
Naguilian, La Union, Philippines, after having been sworn to in
accordance with law, hereby declare and state that:

1. I am a graduate of Saint Louis University, Baguio City with a

degree of Civil Engineering in the year 1984 and for which reason, I was
duly issued a transfer credential (transcript of record) by the same
university. I likewise requested and was granted another copy of my
transfer credential in the year 1992;

2. I have been keeping the same inside our residence at my

above-written address. To date, when I was looking for the said transfer
credential, I could no longer locate the same inside our house and the
same might have been thrown or played with by any member of our
family not knowing the importance thereof;

3. I, and the members of the family, exerted all effort to locate the
same transfer credential to no avail, hence I am declaring them lost and
beyond recovery;

4. I am now requesting Saint Louis University to issue a new

transfer credential in lieu of the lost one and the same is intended for
legal use; and

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

foregoing for all legal intents and purposes it may serve.

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

August 2016 in the City of Baguio, Philippines.

MEDARDO DELIZO FERRERA

Affiant
PhilHealth ID No. 05-025256402-8

SUBSCRIBED AND SWORN to before me this 30 th day of August 2016

in the City of Baguio, Philippines.

ROMEO F. BUSLAYAN, JR.

Notary Public for the City of Baguio
My commission expires on December 31, 2017
IBP Membership No. 2438760-Jan. 4, 2016-Baguio-Benguet
Privilege Tax Receipt No. 1003684-Jan. 4, 2016-Baguio City
N.A. No. 32-NC-16-R

Doc. No. 143; Page No. 29; Book No. XXXI; Series of 2016.