Republic of the Philippines )

City of Cebu )S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, Jan Lloyd B. Oja, of legal age, Filipino, single, and a resident of Caridad Sur, Matalom, Leyte, after
having been sworn in accordance with law, hereby deposes and states the following:

1. I am holder/owner/ or possessor of the following document: CERTIFICATE OF

COMPLETION for successfully completing the training course in Basic Training issued by the
Maritime Training Center;
2. Being issued to me last, March 27, 2018 for participating the Basic Training Seminar last
March 19-27, 2018
3. On April 2018, the original copy of the Certificate of Completion could not be found, which I
believed has been lost in the school grounds;
4. Despite diligent search and best efforts, I failed to locate and recover the said Certificate to
this day;
5. Wherefore, I am executing this Affidavit of Loss to attest to the truth of the foregoing and for
whatever legal purposes that this may serve;

Signed on the date and at the place indicated below.

JAN LLOYD B. OJA

School Id: 1090626

SUBSCRIBED AND SWORN TO before me, a notary public in and for Cebu City this ____ of _________,
2018. The affiant, whom I identified through the following competent evidence of identity: School
ID No. 1090626, issued by University of Visayas, personally signed the foregoing instrument before
me and vowed under penalty of law to the whole truth of the contents of said instrument.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No. _______

Page No. _______
Book No. _______
Series of _______