REPUBLIC OF THE PHILIPPINES)

CITY OF ILIGAN ) S.S.

x-------------------------------------x

AFFIDAVIT OF LOSS

I, CHERYL LOU B. CALES, of legal age, Filipino, single, and a

resident of Puga-an, Iligan City, after having been duly sworn to in
accordance with law, depose and state THAT:

1. I was issued a Baptismal Certificate at Angeles City,

Pampanga;
2. Sometime on December 2011, the abovementioned certificate
was washed away by Tropical Storm Sendong;
3. The said certificate is now beyond recovery;
4. I am executing this affidavit to attest to the truth of the
foregoing facts and to use the same for whatever legal
purpose it may serve.

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

day of _______________, 2017 at Iligan City.

CHERYL LOU B. CALES

Affiant

SUBSCRIBED AND SWORN to before me, this _______ day of

____________, 2017 at Iligan City, with affiant exhibiting to me his
______________________________________________, issued on
_______________________ at ___________________.