REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) S.S.

MUNICIPALITY OF TAGO)
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AFFIDAVIT OF LOSS

I, DEZZA URBIZTONDO ABARRO, Filipino, of legal age, and a

resident of Brgy. Bungtod, Tandag City, Surigao del Sur, after having
been sworn to in accordance with law, avers - THAT:

1. I am presently a Grade 7 teacher of Jacinto P. Elpa National High

School, Tandag City, Surigao del Sur;

2. I was entrusted with one Gong (musical instrument), a property of

the school, sometime in December 2014 which was used during
the conduct of a Cultural Presentation at Jacinto P. Elpa National
High School;

3. I however lost the Gong inside the school where I left it

accidentally. I tried my best effort to locate the whereabouts of the
musical instrument, but I cannot find it anymore despite my
diligent search;

4. I am executing this Affidavit to attest to the truth of the foregoing

facts and for whatever legal purpose this may serve;

AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this 19th

day of April, 2017, in Tago, Surigao del Sur.

DEZZA URBIZTONDO ABARRO

Affiant

SUBSCRIBED AND SWORN to before me this 19th day of April,

2017, in Tago, Surigao del Sur, affiant exhibited to me her competent
evidence of identity and after being satisfied that she understood and
voluntarily executed this Affidavit.