REPUBLIC OF THE PHILIPPINES……)

PROVINCE OF SULTAN KUDARAT…) S.S.

CITY OF TACURONG………………....)
x…………..……………………………………x

AFFIDAVIT OF LOSS

I, ELIZABETH D. BARBOSA, of legal age, Filipino, married and resident of

Tacurong, Sultan Kudarat, after having been duly sworn to in accordance with law, do
hereby depose and say, that:

1. I am the current accountant of Sultan Kudarat State University;

2. That a Development Bank of the Philippines (DBP) check with the following
information was under my possession:
a. Payee: ALPABITO R. MECENAS, JR.
b. Check Number: 50706252
c. Amount: One Hundred Forty Seven Thousand Five Hundred Pesos
Only (P147, 000.00)
3. That the above check has already been staled for failure of the payee to
encash the same;
4. That the above check has been lost inside my office and I cannot anymore
locate the same;
5. I exerted diligence effort in locating the said check in my office and checking
all the corners of my office and all my drawers but I could not find it;
6. I executed this affidavit freely and voluntarily and hereby attest the veracity
of the foregoing declaration under pain of perjury and for whatever legal
intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 27 th day of October,

2017 at Tacurong City, Sultan Kudarat, Philippines.

ELIZABETH D. BARBOSA
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of October, 2017 at

Tacurong City, Sultan Kudarat, Philippines.