Republic of the Philippines )

Province of Isabela )S.S.

______________ )
x---------------------------------x

AFFIDAVIT OF LOSS

I, AAAA, of legal age, Filipino, single, a resident of Zone 7 Tallang,

Baggao, Cagayan, and presently employed at the Public Attorney’s Office,
Cabagan, Isabela, after having been duly sworn to in accordance with law, do
hereby depose and state:

1. That I am the duly authorized agent of the Philippine Charity

Sweepstakes Office (PCSO), Cagayan to operate Lotto and Keno at
_____________

2. That due to the present health crisis that hampered movement and
transportation, I was not able to submit the weekly settlement reports of the two
(2) outlets, to wit:

______

3. That during the onslaught of the typhoon “Ulysses”, the said reports
were lost as a result of the massive flooding caused to the ____________ where
they have kept;

4. That I executed this Affidavit to attest to the truth of all the

foregoing facts, and for any other lawful intent and purpose it may serve.

AFFIANT FUTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this December 4,

________, Philippines.

BBBBB

SUBSCRIBE AND SWORN to before me this December 4, 2020 at

_______. Affiant exhibited to me his Identification Card, bearing his photograph
and signature, as competent evidence of her identity.