REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.

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AFFIDAVIT OF LOSS
I, JEOFREY AMBATANG y OMAWENG, of legal age, married, Filipino and a
resident of 20 Recto Avenue, Rosario, Santiago City, after having been duly sworn to in
accordance with law, do hereby deposes and states:

1. That I am undergraduate student of Edenton Mission

College, Inc. Maitum, Sarangani Province for Bachelor in Secondary
Education last June 2010 to October 2010;

2. That after the said semestral period, I went to Malaysia to

work as an Overseas Contract Worker;

3. That I personally secured a copy of my Original Transcript of

Records issued by the Registrar’s Office of Edenton Mission College,
Inc.sometime in the year 2017;

4. That the said copy of my Original Transcript of Records

was accidentally lost sometime on Sepember, 2017 at Las Piñas, Manila
and despite diligent efforts to locate it, the same could not be found and
beyond recovery;

5. That I am requesting the Registrar’s Office of Edenton

Mission College, Inc. for another copy of my Original Transcript of
Records pertaining to my intention to continue my studies. Likewise, I am
humbly requesting the proper Office concerned to issue the following
documents needed for my enrollment enumerated as follows:

(1) Certificate of Honorable Dismissal;

(2) Certificate of Good Moral Character

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of June,
2018 at Santiago City.

JEOFREY AMBATANG y OMAWENG

Affiant
NBI Id no03661882

SUBSCRIBED AND SWORN to before me this 8th day of June, 2018 at

Santiago City.

Doc. No. ____ ATTY. RICHARD V. GOMEZ

Page No. ____ Notary Public Until December 31, 2019
Unit 5, Mango Suites, Calao East, Santiago City
Book No. ____
MCLE Compliance No. New Member
Series of 2018 IBP No. 019412/IBP National Office, Pasig City/12-27-2017
PTR No.SC 2403556/Santiago City/01-08-2018
Attorney’s Roll No. 69120/05-30-2017
Notarial Commission No. 0203
Tel. No. (078) 305-2392
REPUBLIC OF THE PHILIPPINES}
SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS

I, JUN JUN SEDICO, of legal age, married, Filipino, and a resident of Brgy. Gud,
San Isidro, Isabela, after having been duly sworn to in accordance with law, do hereby
depose and state:

1. That I am the holder of an OFFICIAL RECEIPT issued by the Land

Transportation Office (LTO), Santiago City;

2. That said OFFICIAL RECEIPT was accidentally lost sometime on

September 2013 at San Isidro, Isabela, and despite diligent efforts to
locate it, the same could not be found and is now beyond recovery;

3. That I am executing this affidavit to attest to the fact of loss of said

OFFICIAL RECEIPT and to inform the LTO-Santiago City and to request
further for the renewal of my Driver’s License even without the said Official
Receipt;

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of March,
2014 at Santiago City.

JUN JUN P. SEDICO

Affiant

License ID No.B06-086-000317

SUBSCRIBED AND SWORN to before me this 7th day of March, 2014 at

Santiago City.
Doc. No. ____
Page No. ____
Book No. ____
Series of 2014

REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS

I, REYGHIE S. PANTALEON, of legal age, single, Filipino and a resident of

District 4, San Manuel, Isabela, after having been duly sworn to in accordance with law,
do hereby deposes and states:

1. That I am the holder of Permit for Examination issued by AMA Campus,

Santiago City;

2. That said PERMIT was accidentally lost sometime last month of

January, 2013 at Santiago City, and despite diligent efforts to locate it, the
same could not be found and beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of said
PERMIT and to inform the AMA Campus, Santiago City;

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of February,
2013 at Santiago City.

REYGHIE S. PANTALEON
Affiant

Philhealth ID No. 06-050076335-6

SUBSCRIBED AND SWORN to before me this 1st day of February, 2013 at

Santiago City.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2013
REPUBLIC OF THE PHILIPPINES}
SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS

I, JERRY F. URBANO, of legal age, married, Filipino and a resident of

Barangay Doña Paulina, San Isidro, Isabela, after having been duly sworn to in
accordance with law, do hereby deposes and states:

1. That I am the holder of PROVISIONAL RECEIPT No. 002162 and

002170, issued by Manulife, Santiago City Branch, Santiago City;

2. That said PROVISIONAL RECEIPT was accidentally lost sometime last

month of January, 2013 at Santiago City, and despite diligent efforts to
locate it, the same could not be found and beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of said
PROVISIONAL RECEIPT and to inform the Manulife, Santiago City
Branch, Santiago City;

IN WITNESS WHEREOF, I have hereunto set my hand this 11 th day of

February, 2013 at Santiago City.

JERRY F. URBANO
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of February, 2013 at

Santiago City.

Doc No. _____

Page No. _____
Book No._____
Series of 2013
REPUBLIC OF THE PHILIPPINES}
SANTIAGO C I T Y}: S.S.
x---------------------------------------------x

AFFIDAVIT OF LOSS

I, ANNA FLORABEL N. AYROSO, of legal age, single, Filipino citizen and

a resident of Christine Village, Cauayan City, after having been duly sworn to in
accordance with law, do hereby deposes and states:

1. That I am the holder of SIM CARD No. 09359033158;

2. That said SIM CARD was accidentally lost sometime this month of
January, 2011 at Cauayan City, and despite diligent efforts to locate it,
the same could not be found and beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of said SIM
CARD;

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of January,
2011 at Santiago City.

ANNA FLORABEL N. AYROSO

Affiant

SSS No. 01-2030309-80

Issued at: Cauayan City

SUBSCRIBED AND SWORN to before me this 28th day of January, 2011 at

Santiago City.

Doc No. _____

Page No. _____
Book No.59
Series of 2011

REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.
x---------------------------------------------x
 AFFIDAVIT OF LOSS

I, FE DUMALIANG FLORENTIN, of legal age, married, Filipino citizen and a

resident of Barangay Camarag, San Isidro, Isabela, after having been duly sworn to in
accordance with law, do hereby deposes and states:

1. That I am the agent of Manulife Manufacturers Life Insurance, Branch

Office, Santiago City;

2. That said PROVISIONAL RECEIPT was accidentally lost sometime

last month of February, 2011 at Santiago City, and despite diligent efforts
to locate it, the same could not be found and beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of said
PROVISIONAL RECEIPT and to inform the Manulife Head Office, Makati
City;

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of May,
2011 at Santiago City.

FE DUMALIANG FLORENTIN
Affiant

Dri. Lic. ID No. B12-09-001720

Issued at: Santiago City
Until: 02-23-12

SUBSCRIBED AND SWORN to before me this 26th day of May, 2011 at

Santiago City.

Doc No. _____

Page No. _____
Book No. _____
Series of 2011

REPUBLIC OF THE PHILIPPINES}

SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS

I, MARITA M. TUMAMAO, of legal age, married, Filipino and a resident of

Barangay Gomez, San Isidro, Isabela, after having been duly sworn to in accordance
with law, do hereby deposes and states:
 1. That I am the holder of PREFARRED SHARES (PS) No. 13755, issued
by Fico Bank, Santiago City Branch, Santiago City;

2. That said PREFARRED SHARES was accidentally lost sometime last

year, 2011 at San Isidro, Isabela, and despite diligent efforts to locate it,
the same could not be found and beyond recovery;

3. That I am executing this affidavit to attest into the fact of loss of said
PREFARRED SHARES and to inform the Fico Bank, Santiago City
Branch, Santiago City;

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of May,
2012 at Santiago City.

MARITA M. TUMAMAO
Affiant

Postal Id No. 9622372

Valid Until: August, 2013

SUBSCRIBED AND SWORN to before me this 30th day of May, 2012 at

Santiago City.

Doc No. _____

Page No. _____
Book No._____
Series of 2012