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REPUBLIC OF THE PHILIPPINES ) PROVINCE OF LAGUNA )S.S.

MUNICIPALITY OF SANTA CRUZ)

AFFIDAVIT OF LOSS

I, ALEX AXELLE M. BALDEMORA , of legal age, single, with residence address at Brgy. Sto Nio, Lumban, Laguna, after and having been duly sworn in accordance with law hereby voluntary depose and say: 1.- That I am the holder of Reprot Card Form 1-37 and Form 1-38 issued to me at Saint Vincent de Paul Montisori and Science High School, at Lumban, Laguna; 2. That on August , 2012 our house was inundated by the water from Lake Laguna and many of our personal things in our house were destroyed and swept away by the flood, and among them is the said Report Card ( Form 1-37 and Form 1-38; 3.- That we were not able to save the aforesaid Report Card because we had to evacuate to higher grounds and so the same should now be considered as lost and beyond recovery; 3.- That I am executed this statement to attest to all the above facts, and not for the purpose of fraud or any unlawful purpose. IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of April 2013 at Santa Cruz, Laguna ALEX AXELLE M. BALDEMORA Affiant SUBSCRIBED AND SWORN to before me this 8th day of April, 2013 at Santa Cruz, Laguna, by Alex Axelle M. Baldemora, who has satisfactorily proven to me his identity through his student ID NO.______________and that he is the same person who personally signed before me the foregoing affidavit and acknowledged that he executed the same.

Doc No. 463 Page No. 94 Book No. XXVII Series of 2013

DIOMEDES A. PEREZ Notary Public Until Dec. 31, 2014 PTR NO. 0799331 1/23/12 SCL IBP NO. 907408 1/22/13 SPC Roll No. 22735

WARD MISSIONARIES AND THEIR PERSPECTIVE ASSIGNMENTS DISTRICT-1 CAL-BAG 1-3 DISTRICT-2 BAGUMBAYAN 46 AGUADO,EDMUNDO AND EDITA-HT/VT ALFONSO, RAYMUND GLENN ROXAS-HT/VT ALOBA FAMILY (STEVEN)-CM ARRIENDA, ROWENA OLOPERES-VT RODELLAS-VT BALASE-ALOBA MADONNA-CM BORGONIA FAMILY (MARK EVANS)-CM CM) CAMBEL FAMILY (EDGARDO )-CM HT (BERTING)-CM REYMARK ADOVISO-HT CONDINO FAMILY CM CAROLYN-VT AND ROSE MARIE-VT CORTEZ FAMILY (EDNA)-CM TOLENTINO -VT DATAY FAMILY (BENEDICTO)-CM DELA TORRE FAMILY (NENITA)-CM DE MESA, MARICEL VT ESPIRITU FAMILY (BISHOP)-CM CARRILO FAMILY-CM CORO FAMIL Y -CM DAVI, MARY JANE BIRISO-VT DE LANTAR FAMILY -CM DELA PAZ, ILUMINADA ELCA -VT DE LIMA, EUFRONICA-VT DE LIMA, FLORIDA -VT ELCA, ARMAN ELCE, ANGELES FAMILY (CATHY)-CM ANTONIO SISTERS (3)-VT AQUINO, JAYCEE RIVERA -HT AQUINO, MARY GRACE

ARGANDA FAMILY (APOLO)-CM BALTAZAR FAMILY (LUZVIMIN-

BARCENAS, ALLAN BAUTISTA BARCENAS FAMILY BAUAL,

BLANCO, CARMINA AND BLAZO, RITA

BONIFACIO FAMILY-CM CALVARIO, MARIFE

AND RODOLFO-HT ROMANO-HT ESPIRITU FAMILY (CHRISTIAN)-CM FRANCIA, MANOLITO-HT

DISTRICT-3 GATID-DUHAT LABUIN ACIBAR, RUBYANN BERMUDEZ-VT ADRIANO FAMILY-CM AGOC, GERALD EARL BARROSO-HT VT AL KHALAILEH, HOSAM RAQUEPO-HT ALVAREZ FAMILY (ROSITA ARANTON)-CM ALVAREZ, ADELAIDA AND EVANGELINE-VT MACUGUE-VT ALVAREZ, EMERCIANA AND FELOMINA-VT BERMUDEZ, FELICIANO AND SHEILA-CM BERMUDEZ, MYLENE AND GERALDINE-VT CALINAGAN, ARMANDO AND JOAN-HT/VT DIEZ FAMILY (LYAN ROSS)-CM DOMETITA FAMILY (BENEDICT)-CM ELCA, ESPERANZA (MUNTING GATID)-VT ELCA, RODOLFO (DUHAT)-HT REGINA-VT ESTOLONIO FAMILY-CM

DISTRICT-4

BUBUKAL-

ACO FAMILY-CM ALVAREZ, MARICRIS CALO-VT BASBAS, LOLITA HERNANDEZ-

BONZA FAMILY-CM CABALUNA FAMILY-CM CALASICAS, ROSENDA

CALCETAS FAMILY-CM CAMUS, NENITA CHAVEZ-VT CASTILLO FAMILY (NARLY)-CM CATANGUI FAMILY-CM CORTEZ FAMILY-CM DE LEON FAMILY (ROSARIO)-CM DELOS SANTOS FAMILY-CM DIVINAGRACIA FAMILY-,

ELCA FAMILY (JAIME)-CM ESTRADA FAMILY (JUN)-CM ESTRADA FAMILY (LEONARDO)-

CM

DISTRICT-5 SAN JUAN-OOGONG ALVAREZ FAMILY ( DYNALOU RASON)-VT AVILA, VILLY JOE RASONABLE-HT BULAN, REYNALYN MAGSISI-VT DE LEON, SONNY AND DONNY-HT