Republic of the Philippines)

City of Davao . . . . . . . . )s.s.

x---------------x
AFFIDAVIT OF LOSS
I, RUTH DE JOSEPH CHAVEZ, of legal age, Filipino, married to
ALLAN CHAVEZ and a resident of Davao City, Philippines, after having been
duly sworn to in accordance with law, hereby depose and say:
That our children Angel Felicity De Joseph Chavez and Ethan Matthew
De Joseph Chavez students of ______________________, no longer went
to school since July 2014;
That I have been keeping their Form 138 including all their pertinent
documents related to their school inside our cabinet;
That when we transferred our residence last July 2014 and the time
came for me to try to locate the said documents, I discovered that it was
missing, prompting me to exert efforts to look for the same; however,
despite due diligence in trying to locate the said documents, the same could
no longer be found and is now considered lost for all intents and purposes;
That I am executing this affidavit to attest to the truth of the foregoing
statements and to apprise those concerned that the same was simply lost
and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this
__________ at Davao City, Philippines.
RUTH DE JOSEPH CHAVEZ
Affiant
SSS NO._______________
SUBSCRIBED AND SWORN to before me this ___________ in the
City of Davao, Philippines by the affiant, exhibiting to me his competent
evidence of identity indicated above.

Doc No.___;
Page No.___;
Book No.___;
Series of 2015