REPUBLIC OF THE PHILIPPINES )

CITY OF SILAY . . . . . . . . . . . . . . . ) SS.

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AFFIDAVIT OF LOSS

I, ROSA A. ATOTUBO, of legal age, Filipino and a resident of Talisay City, Negros
Occidental, Philippines, after having been sworn in accordance with law, do hereby depose and
say:

That I am the Property Custodian of Catabla Baybay Elementary School;

That as Property Custodian, I am also in-charge of all books issued to the school at the
start of the school year;

That I recently discovered that the following books were lost:

 10 pcs. TX1 Pagpanghanda ng mga Kasampaton
 7 pcs. TX 1 Mother Tongue Base Multi-Lingual Education
 2 pcs. TX 1 Edukasyon Sa Pagpapakatao
 5 pcs. LM in Araling Panlipunan 3 rd to 4 th Quarter
 2 pcs. LM in English
 4 pcs. LM in Music
 3 pcs. LM in Physical & Health 1 st, 2 nd, 3 rd & 4 th Quarter
 7 pcs. LM in Edukasyon Sa Pagpapakatao
 4 pcs. LM: Ortograpiya
 10 pcs. LM in Mother Tongue Base Multi-Lingual Education I
 7 pcs. LM in Math I
 2 pcs. LM in Mother Tongue Base Multi-Lingual Education 3
 5 pcs. LM in Mathematics 3
 1 pc. TX 6 Into the Future Science and Health
 1 pc. TX 6 English for All Times
 1 pc. TX 6 English for You and Me Language
 1 pc. TX 6 English for You and Me Reading

That all efforts to find the said books were done but are now believed to be lost beyond
recovery;

That I am executing this affidavit to the attest to the truth of the foregoing statements.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of

__________2017, in Silay City, Philippines.

ROSA A. ATOTUBO
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _____ day of ____________, 2017, in

Silay City, Philippines.