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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF AKLAN )S.S.


MUNICIPALITY OF KALIBO )
x-------------------------x

AFFIDAVIT OF LOSS

I, ISAIAH JERU JIMINEZ, of legal age, single, Filipino, and a resident of Purok 2, C. Laserna St.,
Poblacion, Kalibo, Aklan, after having been duly sworn to in accordance with law, do hereby depose and say:

1. That I was issued and the holder of the following described pertinent documents, to wit:

1-1. Seaman’s Book, issued by the Philippines' Maritime Industry Authority (MARINA), Jaro, Iloilo
City, issued on November 6, 2016;

1-2. Philippine Passort, issued by the Department of Foreign Affairs (DFA), Iloilo, City, issued on
November 9, 2016;

2. That on various dates, I underwent the required/necessary training for a sea mariner, and as such, I was
issued the following described documents/certificates by the respective training center, to wit:

2-1. That on July 18, 2016, I took a SOLAS Basic Training with Exact Training Center, Iloilo Branch,
and was issued a SOLAS Basic Training Certificate, issued on July 23, 2016;

2-2. That on July 18, 2016, I took an SDSD Training with Exact Training Center, Iloilo Branch, and
was issued an SDSD Training Certificate, issued on October 7, 2016;

2-3. That on June 29, 2016, I took a Deckwatch Keeping Training with Pentagon Maritime
Foundation, Taft Ave., Ermita, Manila, and was issued a Deckwatch Keeping Training Certificate,
issued on July 3, 2017;

3. That on July 18, 2017, at a Landbank located at Quezon City, my backpack (bag), which contained all of
my aforecited documents mentioned under paragraphs 1 and 2, was unlawfully taken from me by a
“budol-budol gang”; Said incident is shown in a Philippine National Police (PNP), blotter certification,
issued the Quezon City Police District Office, Masambong Police Station;

4. That said backpack (bag) including the said documents contained therein can no longer be recovered
despite diligent efforts exerted to recover the same, and now I consider the said backpack (bag) including
the above-mentioned documents lost beyond recovery;

5. That said backpack (bag) and the above-mentioned documents were never confiscated from me by any
competent authority or delivered to any person/entity to secure any obligation;

6. That I am executing this affidavit to attest to the truth of the foregoing facts for all legal intents and
purposes and in particular.

IN TESTIMONY WHEREOF, I have hereunto set my hand this May 22, 2018 at Kalibo, Aklan.

ISAIAH JERU JIMENEZ


Affiant
BRGY. ID Card No. 2017-0081101101034;
Issued at Barangay Aguado, City of Trece Martires, Cavite;

SUBSCRIBED AND SWORN to before me this May 22, 2018 at Kalibo, Aklan.