Republic of the Philippines

Province of Bulacan

)
) S. S.

JOINT AFFIDAVIT OF LOSS

We, BIBIAN B. VILLANUEVA and EVELYN G. AGUDO , both of legal
age, married, Filipino citizens, and residents of Barangay Calawitan and
Gabihan, respectively, San Ildefonso, Bulacan, after having been sworn to in
accordance with law, hereby depose and say:
1. That, we are employees of the Municipality of San Ildefonso,
Bulacan, Treasurers office;
2. That, on January 19, 2015, we receive a Metrobank check with
number 4730017235 dated January 14, 2015 amounting to THREE
HUNDRED FORTY SEVEN THOUSAND, NINE HUNDRED THIRTY NINE
&
33/100
pesos
(P347,939.33)
from
JOLLIBEE
FOODS
CORPORATION as payment for business permit and other related
fees;
3. In relation to the previous paragraph, a corresponding Official
Receipt with number 3273133 dated January 19, 2015 was issued;
4. Since yesterday, as we are looking for the said check, the same
could not be found;
5. That, we took pains to look for said check, but to no avail;
6. That, we are executing this affidavit to attest to the truth of the
foregoing and for other legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 21 st day of
January, 2015 in Bulacan, Philippines.
BIBIAN B. VILLANUEVA
Affiant

EVELYN G. AGUDO
Affiant

SUBSCRIBED AND SWORN to before me this 21 st day of January, 2015

in Bulacan, Philippines.
Notary Public
Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 2015.