Republic of the Philippines)

Olongapo City .) S.S.

AFFIDAVIT OF LOSS
I, MYRTLE JUDE M. ANTONIO, of legal age, single, Filipino, and presently
residing at 19 Caron St. West Bajac-bajac Olongapo City, after having duly sworn to in
accordance with law, hereby depose and state:
1.

That I am a student of Gordon College located in Olongapo City

Philippines;

2.

That sometime this October 2015, I inspected my personal school

documents to prepare for the upcoming school enrollment, I found out that
my Enrollment Form or E-form was missing;

3.

That despite diligent effort to locate the same, all efforts proved fruitless as
up to the present and fear that the same has been lost somewhere and
beyond recovery; and

4.

That I am executing this affidavit of loss to attest to the truth of the

foregoing, to request for re-issuance of my lost Enrollment Form or Eform and for whatever legal purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affix my signature this 21 st day of
October 2015 at Subic Bay Freeport Zone, Olongapo City, Philippines.

MYRTLE JUDE M. ANTONIO

-Affiant SUBSCRIBED AND SWORN to before me this 21st day of October 2015 at
Subic Bay Freeport Zone. Affiant exhibited to me his Student ID No. 201210080 as
proof of his personal identification.

Doc No.: 255;

Page No. 52;
Book No.
XI;
Series of 2015.