REPUBLIC OF THE PHILIPPINES)

PAGADIAN CITY.)S.S.

AFFIDAVIT OF LOSS

I, JESSEL T. BEDUYA, of legal age, married, and resident of Barangay Dao,

Pagadian City, after having been duly sworn to, in accordance with law, hereby deposes
and states: That-

1. I am a member of SEVENTH DAY ADVENTIST Dao, Pagadian City;

2. As such ,as a member of said religious group we have an activity every October
called Harvest Ingathering and every one of us are given by the church a
Solicitors Card/O.R. to be distributed;

3. Sometime in November 2016, I can still remember that I placed the said Solicitors
Card/O.R. inside my bag before I went out to church;

4. That to my surprise, after I went back to our house from the church, I then
discovered that said Solicitors Card/O.R. was no longer inside my bag from which
I placed the same;

5. I then immediately trace my way back to the church to locate the said Solicitors
Card/O.R. but to no avail;

6. Despite diligent search and efforts to locate said Solicitors Card/O.R., I could not
find the same such that I now believe that said Solicitors Card/O.R. is lost beyond
recovery;

7. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and in support of remittance of the Solicitor/O.R. to the Western
Mindanao Conference.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of December
2016 at Pagadian City, Philippines.

JESSEL T. BEDUYA
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of December 2016 in

Pagadian City, Philippines.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.