AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES CITY OF GENERAL SANTOS S.S

I, JODEL ABAD QUIJANO, of legal age, Filipino, single and esiding a! P" o# $, Ladol, Ala%el, Sa angani, af!e %eing s&o n !o in a''o dan'e &i!( la&, (e e%) depose and sa)*

T(a! I a+ a la&f"l (olde and possesso of a College ,iplo+a d"l) iss"ed %) Ra+on -agsa)sa) -e+o ial College.Penda!"n A/en"e, Gene al San!os Ci!)* T(a! on O'!o%e 0, 1233 !(e a%o/e +en!ioned 'ollege diplo+a &as %" ned a! Gene al San!os Ci!)* T(a! I e4e !ed +) %es! effo ! !o e'o/e !(e sa+e %"! !o no a/ail* T(a! !(e afo e+en!ioned 'ollege diplo+a &as no& %e)ond e'o/e ). T(a! I a+ e4e'"!ing !(is affida/i! !o a!!es! !o !(e ! "!( and /e a'i!) of !(e fo egoing s!a!e+en!s. IN WITNESS WHEREOF, I (a/e (e e"n!o se! +) (and !(is 15!( da) of 6an"a ), 1237, in !(e Ci!) of Gene al San!os, P(ilippines.

JODEL ABAD QUIJANO

Affian!
Li'ense No. L27.33.220890

SUBSCRIBED AND SWORN !o %efo e +e, !(is 15!( da) of 6an"a ), 1237, a! Gene al San!os Ci!), P(ilippines. Affian! e4(i%i!ed !o +e (is d i/e :s li'ense no. & i!!en %elo& (is na+e.

Doc. No: P"#$ No. Boo' No. S$)*$+ o,

311 %3 (((II 2014.

ATTY. JOSE EDMAR J. YUMANG NOTARY PUBLIC, GSC DECEMBER 31, 2015 ROLL NO. 57439 IBP NO. 9423!9 TIN NO. 1%1&923&9%! PTR NO. 00000 GS&530191%
MCLE COMP. NO. I-&001534% .4/0 Co123*"4c$ P$)*o56