Republic of the Philippines)

Province of Davao del Sur)S.S.

City of Digos )

AFFIDAVIT OF LOSS

I, , of legal age, single , Filipino Citizen and a resident of Digos City,

Davao del Sur, Philippines after having been duly sworn to in accordance with
law do hereby depose and state:

That I am the same and identical person who caused the execution of this
instrument;

That I am presently the Digos City Consultant of Tourism under the Office
of City Mayor;

That I have been ordered by the City Mayor Arsenio “Boy” Latasa to
travel to Iloilo under a Memorandum order duly issued by said Office.

That I traveled to Iloilo and was issued a Registration Fee Receipt when I
traveled to Iloilo.

However, I thought I have kept all my travel documents like Registration

Fee for liquidation purposes.

But when I checked said travel documents I have discovered that the
Registration Fee was lost inadvertently.

That I exerted diligent effort in finding said Registration Fee Receipt

but it turn out to be futile and cannot be found despite my tireless efforts;

That I am executing this instrument to inform concerned Government of

the lost of the said Registration Fee Receipt and attest to the truth and
veracity of the same;

IN WITNESS WHEREOF, I have set my hand this 15 th day of October 2008

at Digos City, Davao del Sur, Philippines.

TEODORICO N. DOFILES II
AFFIANT

SUIBSCRIBED AND SWORN to before me this 17th day of October 2008 in

the Coty of Digos, Davao del Sur, Philippines.

DOC.No. ;
Page No. ___;
Book No.____;
Series of 2008