AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)

CITY OF DIPOLOG ) S.S
x--------------------------------------------x

I, LUZVIMINDA ACABAL YBAEZ, of legal age, Filipino, married and a resident of

Larayan, Dapitan City, Zamboanga del Norte, after having been duly sworn to in
accordance with law, depose and state THAT:

1. THAT I am the holder of an AFPSLAI Passbook which dated back sometime in

1976 when I was appointed as Patrolwoman of Dapitan City Integrated
National Police as evidenced by my AFPSLAI ID No. 71646, Xerox copy of the
same is hereto attached and marked as Annex A;

2. THAT sometime about year 2004 I was looking for my green passbook where
my capital contributions was deposited for the purpose of updating my
deposits;

3. THAT despite earnest efforts to locate my passbook, the same could not be
found and therefore is considered lost and missing;

4. That I am executing this affidavit to attest to the truth of the foregoing facts and
in connection with my request for the issuance of a new passbook in lieu of the
lost one.

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

June, 2017 at Dipolog City.

LUZVIMINDA ACABAL YBAEZ

Affiant

SUBSCRIBED AND SWORN to before me, this ______day of June, 2017 in

Dipolog City, with affiant exhibiting her AFPSLAI ID No. 71646. Issued on 2001 at
Dipolog City.

NOTARY PUBLIC

Doc. No. :__

Page No. :__
Book No. :___
Series of 2017.
 REPUBLIC OF THE PHILIPPINES)
CITY OF DIPOLOG ) S.S.
x-------------------------------------x

AFFIDAVIT OF LOSS

I, IRISH A. CIMAFRANCA, of legal age, Filipino, single and a resident of

Isis,Polanco, Zamboanga del Norte after having been duly sworn to in accordance with
law, depose and state:

1. That I am a graduating student of STI Dipolog

2. That despite diligent effort to locate all my school records particularly FORM-137 the
said records were either lost or misplaced and presumed to be missing as I took it for
granted ;

3. That considering that I am graduating this school year I was required to submit all my
financial school records thus I was constrained to submit the said records to the
school authorities;

5. That in view thereof, I am now executing this affidavit to support my graduation papers
as required by the school and for any legal purpose it may served

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of March
2017 in Dipolog City, Philippines.

IRISH A. CIMAFRANCA
Affiant
Student ID No. 135-0163-2014

SUBCRIBED AND SWORN TO before me this 15th day of March 2017 in Dipolog
City, Philippines, affiant exhibiting to me his valid proof of identification.

Doc. No. 19;

Page No. 4;
Book No. 1;
Series of 2017
1. I had earnestly tried to look for the said Pantawid ID but the same could not be found;
2. Despite diligent search and effort to locate the said ID, I could not find the same such
that I believe that it is now lost beyond recovery;