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Republic of the Philippines)

Province of Southern Leyte) s.s.


Municipality of Tomas Oppus )
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AFFIDAVIT OF LOSS

I, NORLYN L. BORONG, of legal age, Filipino and a resident of ____________


______________________, after having been duly sworn to an oath in accordance
with law, hereby depose and say:

l. That I was a passenger of Cebu Pacific Flight No. ___________ from


Tacloban to Manila last December 5, 2018 and Air Asia Flight No. ____________
Manila to Tacloban last December 9, 2018;

2. That as such, I was issued a boarding pass related to the said flight by
the aforementioned airline;

3. That sometime on December 10, 2018, the aforementioned boarding


pass got lost and nowhere to be found;

4. That I exhaustive efforts were exerted to locate the same but my search
proved futile as I could not locate the same up to present;

5. That I executed this affidavit in order to attest to the truthfulness and


veracity of the foregoing so that I may be reimbursed by the school for the
airfare and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 31st day of


December, 2018 in the Municipality of Tomas Oppus, Southern Leyte, Philippines.

, NORLYN L. BORONG
Affiant
TIN NO. 917-637-849

SUBSCRIBED AND SWORN to before me this 28th day of December, 2018 at


Tomas Oppus, Southern Leyte, Philippines.