Republic of the Philippines )

City of Iloilo
) S.S
X-----------------------------------X
AFFIDAVIT OF LOSS
I, MA FE TALENTO ARROZ , of legal age, married, Filipino and resident of Pavia,
Iloilo, Philippines after having been duly sworn to in accordance with the law, hereby
depose and say;
That, I am the keeper of the book (Landas sa Pagbasa) of my Son Scoth
Anthony J. Arroz II given by Iloilo Central Elementary School.
That, the said book was destroyed, Mutilated, and lost beyond my control and its
whereabouts and constitution could not be ascertained anymore despite diligent efforts
in my part having been exerted;
That, I execute this affidavit to attest to the truthfulness of the foregoing
declarations;
In witness whereof, I have hereunto affix my signature this 30th day of March ,
2015 at Iloilo, Philippines.
MA FE TALENTO ARROZ
Affiant
Competent Evidence of Identity
Philhealth ID Card No. 11-0502729241
SUBSCRIBED and SWORN to before me this _____ day of ______, 2015 at Iloilo city,
Philippines, affiant exhibited her Philhealth ID Card duly indicated below her name. I
hereby certify that I have examined the affiant and she acknowledges to me the
foregoing declarations are voluntarily made according to her personal knowledge.