Republic of the Philippines )

City of Calbayog ) s.s.

AFFIDAVIT OF LOSS
(Re: Lost Books)

I, ABEGAIL G. NIETO, Filipino, minor, and a resident of Barangay Malajog,

Calbayog City, Samar, Philippines, assisted by my mother MELANIE G. NIETO,
Filipino, of legal age, and a resident of Barangay Malajog, Calbayog City, Samar,
Philippines after having been duly sworn to in accordance with law, hereby depose
and state, that:

1. I am a Grade 10 student of the Calbayog City National High School for

this academic year and as such I was issued the following books for my
use, to wit:

a. Science 10;
b. Music and Arts 10;
c. Physical Education and Health 10;
d. Edukasyon sa Pagpapakatao;

2. Sometime this year, I inadvertently misplaced the abovementioned books

in my possession and I only found out that the same was missing after
my class teacher asked for it;

3. I exerted earnest efforts to locate the said book, but to no avail;

4. I am executing this Affidavit to attest to the truth of the foregoing facts

and for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of

April 2019, at Calbayog City, Samar, Philippines.

ABEGAIL G. NIETO
Affiant

MELANIE G. NIETO
Mother/ guardian

SUBSCRIBED AND SWORN TO BEFORE ME, this 22nd day of April 2019,
at Calbayog City, Samar, Philippines.

LOUIE O. SAJONIA
Public Attorney II
Pursuant to RA 9406