Republic of the Philippines )

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, IAN ROMEO AYA-AY MORING, Filipino, of legal age, married and a resident of Poblacion,
Baclayon, Bohol, Philippines, after being duly sworn to in accordance with law, herby depose and say:

1.) That I am the possessor and in possession of the following items, to wit:
1. Social Security System (SSS) Identification Card (ID) issued by the SSS
2. Tax Identification Number (TIN) Card issued by the Bureau of Internal Revenue (BIR)
3. Philippine Health Insurance Corporation (PhilHealth) Identification Card issued by
the PhilHealth
4. Professional Driver’s License Issued by the Land Transportation Office, Tagbilaran
City

2.) That the aforementioned items were lost when my wallet containing the same fell down from
my pocket somewhere in Tagbilaran City while I was riding on my Tricycle going to Dao District,
Tagbilaran City;

3.) That I exerted effort to find them, but the same could not be found;

4.) That there is a reasonable ground to believe that the same could no longer be recovered;

5.) That the aforementioned items are not in the hands of any third person or of person in authority
for valued consideration;

6.) That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

IAN ROMEO AYA-AY MORING

Affiant

Signed in the presence of:

_______________________ _______________________

SUBSCRIBED AND SWORN to before me this ________ day of _______________________ at the

City of Tagbilaran, Philippines, by the affiants with his Community Tax Certificate No. ________________
issued on _____________________, in _____________________________.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2014.
Republic of the Philippines )
City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, LADY JANE M. CARIDO, Filipino, of legal age, single and a resident of Bilar, Bohol, Philippines,
after being duly sworn to in accordance with law, herby depose and say:

1.) That I am a member of Social Security System (SSS) and in possession and custody of a RS-1 SSS
Form;

2.) That the said RS-1 SSS Form was inadvertently misplaced and eventually got lost at home in
Bilar, Bohol, Philippines;

3.) That I exerted effort to find it, but the same could not be found;

4.) That there is a reasonable ground to believe that the same could no longer be recovered;

5.) That the aforementioned item is not in the hands of any third person or of person in authority
for valued consideration;

6.) That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

LADY JANE M. CARIDO

Affiant

Signed in the presence of:

_______________________ _______________________

SUBSCRIBED AND SWORN to before me this ________ day of _______________________ at the

City of Tagbilaran, Philippines, by the affiants with his Community Tax Certificate No. ________________
issued on _____________________, in _____________________________.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2014.
Republic of the Philippines )
City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, IRENEO PACAṄA, Filipino, of legal age, married and a resident of Poblacion, Baclayon, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am the owner of a motor vehicle which is more particularly described as follows:

“Make : Suzuki
Chassis No. : BE4EA104145
Engine No. : E4334042209
Plate No. : 1779GD
MV File No. : 07480000078585

2. That the Certificate of Registration (CR) of the said motor vehicle was misplaced and eventually
got lost at home in Poblacion, Baclayon, Bohol, Philippines;

3. That despite diligent effort to find it, but the same could not be found;

4. That there is a reasonable ground to believe that the same could no longer be recovered;

5. That the aforementioned item is not in the hands of any third person and in the person of
authority for valued consideration;

6. That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

IRENEO PACAṄA
Affiant

Signed in the presence of:

_______________________ _______________________

SUBSCRIBED AND SWORN to before me this ________ day of _______________________ at the

City of Tagbilaran, Philippines, by the affiants with his Community Tax Certificate No. ________________
issued on _____________________, in _____________________________.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2014.
Republic of the Philippines )
City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, A. ALVIN J. UY, Filipino, of legal age, married and a resident of Poblacion, Baclayon, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am one of the heirs of spouses Antonio O. Uy, who died intestate and without known
debts on October 30, 2004 at Ramiro Community Hospital, Gallares St., Tagbilaran City and
Gardenia J. Uy, who died intestate and without known debts on September 10, 2014 at
Englewood Hospital, Bool District, Tagbilaran City, Philippines;

2. That the late spouses Antonio O. Uy and Gardenia J. Uy, during their lifetime, were members of
the Philam Life and were holder of a Policy under Policy No. 0731171055;

3. That after their death of my mother, Gardenia J. Uy, I tried to find the Philam Life Policy in order
to claim any and all benefits due to the heirs of Antonio O. Uy and Gardenia J. Uy but failed to
find it;

4. That there is a reasonable ground to believe that the same could no longer be recovered;

5. That the aforementioned item is not in the hands of any third person or person of authority for
value or consideration;

6. That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

A. ALVIN J. UY
Affiant

Signed in the presence of:

_______________________ _______________________

SUBSCRIBED AND SWORN to before me this ________ day of _______________________ at the

City of Tagbilaran, Philippines, by the affiants with his Community Tax Certificate/ID No.
________________ issued on _____________________, in/by _____________________________.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2014.
Republic of the Philippines )
City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, GIOVANNI D. BONGCAS, Filipino, of legal age, married to Jennie II Vergara and a resident of
Airport Road, Tagbilaran City, Philippines, after being duly sworn to in accordance with law, herby
depose and say:

1. That I am a depositor of East West Bank, Tagbilaran Branch, CPG Avenue, Tagbilaran City,
Philippines;

2. That as a depositor, I was issued a Passbook under Passbook No. 317371;

3. That the above-mentioned Passbook was in my possession and custody, but was inadvertently
misplaced and eventually got lost at home in Airport Road, Tagbilaran City, Philippines;

4. That despite diligent effort to find it, but the same could not be found;

5. That there is a reasonable ground to believe that the same could no longer be recovered;

6. That the aforementioned Passbook is not in the hands of any third person or person of authority
for value or consideration;

7. That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

GIOVANNI D. BONGCAS
Affiant

Signed in the presence of:

Denis Real Bade Cristine Rose B. Cuaresma

SUBSCRIBED AND SWORN to before me this ________ day of _______________________ at the

City of Tagbilaran, Philippines, by the affiants with his Community Tax Certificate No. 26390658 issued
on January 9, 2014, in Tagbilaran City.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2014.
Republic of the Philippines )
City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, ALBERTA REAL BRUA, Filipino, of legal age, widow and a resident of Poblacion, Baclayon, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am a member of the Social Security System (SSS);

2. That as a member of the SSS, I was issued an SSS Identification Card (SSS ID);

3. That the above-mentioned SSS ID was in my possession and custody, but was inadvertently
misplaced and eventually got lost at home in Poblacion, Baclayon, Philippines;

4. That despite diligent effort to find it, but the same could not be found;

5. That there is a reasonable ground to believe that the same could no longer be recovered;

6. That the aforementioned SSS Identification Card is not in the hands of any third person or
person of authority for value or consideration;

7. That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

ALBERTA REAL BRUA

Affiant

Signed in the presence of:

Denis Real Bade Cristine Rose B. Cuaresma

SUBSCRIBED AND SWORN to before me this ________ day of _______________________ at the

City of Tagbilaran, Philippines, by the affiant with her Community Tax Certificate No.
_______________________ issued on _____________________ in Baclayon, Bohol, Philippines.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of _________.
Republic of the Philippines )
City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, GEDEON GUILLANO, Filipino, of legal age, married and a resident of Poblacion, Baclayon, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am the true owner of a motor vehicle by virtue and pursuant of a Deed of Sale of a
Double-Cab Vehicle, dated December 1, 2013 at Tagbilaran City, duly acknowledged before a
Notary Public, Attorney Jodel Theodore C. Cabahug, CPA, as Doc. No. 219; Page No. 45; Book No.
XXIX and series of 2013, which motor vehicle is more particularly described as follows, to wit:

“Make : Suzuki
Type of Body : Double-Cab
Motor No. : F6A-6319633
Serial/Chassis No. : DE51V-789146
Model No. : 2007
Plate No. : YFP-644”

2. That the Certificate of Registration (CR) of the above-mentioned motor vehicle was in my
possession and custody but was inadvertently misplaced and eventually got lost at home in
Poblacion, Baclayon, Philippines;

3. That despite diligent effort to find it, the same could not be found;

4. That there is a reasonable ground to believe that the same could no longer be recovered;

5. That the aforementioned Certificate of Registration (CR) is not in the hands of any third person
or person of authority for value or consideration;

6. That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

GEDEON GUILLANO
Affiant

Signed in the presence of:

_______________________ ______________________

SUBSCRIBED AND SWORN to before me this ________ day of _______________________ at the

City of Tagbilaran, Philippines, by the affiant with his Community Tax Certificate No. 17442273 issued on
January 28, 2015 in Baclayon, Bohol, Philippines.
Doc. No. ______; Page No. ______;
Book No. ______; Series of 2015.

Republic of the Philippines )

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, LORETH JAKE CABALLO, Filipino, of legal age, single and a resident of San Vicente, Baclayon,
Bohol, Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am the owner of a motor vehicle, which is more particularly described as follows, to wit:

“Make : Honda
Type of Body : MC
Motor No. : XRM14E111725
Serial/Chassis No. : XRM14111719
Plate No. : 2265 GI
MV File No. : 0748-00000088733”

2. That the Certificate of Registration (CR) and Official Receipt (OR) of the above-mentioned motor
vehicle was in my possession and custody but were inadvertently misplaced and eventually got
lost at home in San Vicente, Baclayon, Bohol, Philippines;

3. That despite diligent effort to find them, the same could not be found;

4. That there is a reasonable ground to believe that the same could no longer be recovered;

5. That the aforementioned Certificate of Registration (CR) and the Official Receipt (OR) are not in
the hands of any third person or person of authority for value or consideration;

6. That 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 25 th day of May 2015 at the City of
Tagbilaran, Philippines.

LORETH JAKE CABALLO

Affiant

Signed in the presence of:

_______________________ ______________________

SUBSCRIBED AND SWORN to before me this 25 th day of May 2015 at the City of Tagbilaran,
Philippines, by the affiant with his Community Tax Certificate No. 26428041 issued on May 22, 2015 in
Baclayon, Bohol, Philippines.
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 2015.

Republic of the Philippines )

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, GRACIANO ISRAEL, JR., Filipino, of legal age, married and a resident of Poblacion,
Baclayon, Bohol, Philippines, after being duly sworn to in accordance with law, herby depose
and say:

1. That I am a teacher by profession;

2. That as a professional teacher, I was issued a PRC License by the Professional Regulation
Commission, Cebu, Cebu City, Philippines;

3. That my PRC License was in my possession and custody but was inadvertently misplaced
and eventually got lost at home in Poblacion, Baclayon, Philippines;

4. That despite diligent effort to find it, but the same could not be found;

5. That there is a reasonable ground to believe that the same could no longer be
recovered;

6. That the aforementioned PRC License is not in the hands of any third person or person
of authority for value or consideration;

7. That 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 10 th day of June 2015 at the
City of Tagbilaran, Philippines.

GRACIANO ISRAEL, JR.

Affiant

Signed in the presence of:

Manuel Curayag Dennis Emerson Cuaresma

SUBSCRIBED AND SWORN to before me this 10 th day of June 2015 at the City of
Tagbilaran, Philippines, by the affiant with her Community Tax Certificate No.
_______________________ issued on _____________________ in Baclayon, Bohol,
Philippines.
Doc. No. _________;
Page No. _________;
Book No. _________;
Series of 2015.

Republic of the Philippines )

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, AIMIE S. ROXAS, Filipino, of legal age, single and a resident of Landican, Baclayon, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am a graduate of Baclayon National High School, Landican, Baclayon, Bohol,

Philippines;

2. That as a graduate of the above-mentioned school, I was issued a Diploma;

3. That the said Diploma was in my possession and custody but was inadvertently
misplaced and eventually got lost at home in Landican, Baclayon, Bohol, Philippines;

4. That despite diligent effort to find it, but the same could not be found;

5. That there is a reasonable ground to believe that the same could no longer be
recovered;

6. That the aforementioned Diploma is not in the hands of any third person or person of
authority for value or consideration;

7. That 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 ______ th day of August 2015 at
the City of Tagbilaran, Philippines.

AIMIE S. ROXAS
Affiant

Signed in the presence of:

________________________ _______________________

SUBSCRIBED AND SWORN to before me this _______ th day of August 2015 at the City of
Tagbilaran, Philippines, by the affiant with her Community Tax Certificate No.
_______________________ issued on _____________________ in Baclayon, Bohol,
Philippines.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2015.

Republic of the Philippines )

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, ISIDORO G. REALISTA, Filipino, of legal age, married and a resident of Poblacion, Baclayon, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am among the children and surviving legal heirs of the Spouses Victoriano A. Realista and
Gregoria G. Realista, both died intestate and without known debts on May 29, 1964 and April 3,
2007, respectively, in Baclayon, Bohol, Philippines;

2. That after the death of my parents, I am in custody and possession of the owner’s duplicate
copy of an Original Certificate of Title No. 12297, which is more particularly described as follows:

ORIGINAL CERTIFICATE OF THE TITLE NO. 12297

(Lot No. 6409, cad-359-D)
‘’ A parcel of land ( Lot No. 6409, Cad-359-D)situated in the Barrio of Montaṅa, Municipality of
Baclayon, Province of Bohol, Island of Bohol, Bounded on the NW., along line 1-2 by Lot 6410, Cad-359-
D; on the NE., along line 2-3 by Lot No. 6406, Cad-359-D; on the SE., along line 3-4 by Lot 6381, Cad-359-
D; and on the S., along lines 4-5-6 by Lot 6380, Cad-359-D., and along line 6-1 by Lot No. 6422, Cad-359-
D. Containing an area of FOUR THOUSAND TWO HUNDRED AND FIFTY NINE (6,259) Square Meters,
more or less.”

3. That the above-described Original Certificate of Title No. 12297 was inadvertently misplaced and
eventually got lost at home in Poblacion, Baclayon, Bohol, Philippines;

4. That despite diligent effort to find it, but the same could not be found;

5. That there is a reasonable ground to believe that the same could no longer be recovered;

6. That the aforementioned Original Certificate of Title No. 12297 is not in the hands of any third
person or person of authority for value or consideration;

7. That 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 ______ th day of ___________________
at the City of Tagbilaran, Philippines.

ISIDORO G. REALISTA
Affiant

Signed in the presence of:

 ________________________ _______________________

SUBSCRIBED AND SWORN to before me this _______ th day of ____________________ at the

City of Tagbilaran, Philippines, by the affiant with his Social Security System (SSS) Identification Card No.
03-16227079-8 issued by the SSS.

Doc. No. _________; Page No. _________;

Book No. _________; Series of 2015.

Republic of the Philippines )

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, ISIDORO G. REALISTA, Filipino, of legal age, married and a resident of Poblacion, Baclayon, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am among the children and surviving legal heirs of the Spouses Victoriano A. Realista and
Gregoria G. Realista, both died intestate and without known debts on May 29, 1964 and April 3,
2007, respectively, in Baclayon, Bohol, Philippines;

2. That after the death of my parents, I am in custody and possession of the owner’s duplicate
copy of an Original Certificate of Title No. 12301, which is more particularly described as follows:

LOT 4. ORIGINAL CERTIFICATE OF THE TITLE NO. 12301

(Lot No. 6633, cad-359-D)
‘’A parcel of land ( Lot No. 6633, Cad-359-D)Situated in the Barrio of San Roque,
Municipality of Baclayon, Province of Bohol, Island of Bohol, Bounded On the NE., along line 1-2
by Lot 6635, Cad-359-D; on the SE., along line 2-3 by a road.; on the W., along line 3-4 by Lot
6631, Cad-359-D; on the N., along line 4-1 by Lot 6634, Cad-359-D. Containing an area of SIX
THOUSAND FOUR HUNDRED AND FIFTEEN (6,415) Square Meters, more or less.”

3. That the above-described Original Certificate of Title No. 12301 was inadvertently misplaced and
eventually got lost at home in Poblacion, Baclayon, Bohol, Philippines;

4. That despite diligent effort to find it, but the same could not be found;

5. That there is a reasonable ground to believe that the same could no longer be recovered;

6. That the aforementioned Original Certificate of Title No. 12301 is not in the hands of any third
person or person of authority for value or consideration;

7. That 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 ______ th day of ___________________
at the City of Tagbilaran, Philippines.

ISIDORO G. REALISTA
Affiant

Signed in the presence of:

 ________________________ _______________________

SUBSCRIBED AND SWORN to before me this _______ th day of ____________________ at the

City of Tagbilaran, Philippines, by the affiant with his Social Security System (SSS) Identification Card No.
03-16227079-8 issued by the SSS.

Doc. No. _________; Page No. _________;

Book No. _________; Series of 2015.

Republic of the Philippines )

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, ROSEMARIE REAL BADE, Filipino, of legal age, single and a resident of Poblacion, Baclayon, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am the guardian of Paula Angelica Bade Cuarwesma, Filipino, 13 years old, single, and a
resident of Poblacion, Baclayon, Bohol, Philippines;

2. That Paula Angelica Bade Cuaresma is a Grade VII high school student of Holy Name University
(HNU) – Tagbilaran , Tagbilaran City, Philippines;

3. That as a bonafide student of the said school, I was issued a high school handbook;

4. That the said high school handbook was is my possession and custody for safe keeping, but
unfortunately, the said high school handbook was misplaced at home in Poblacion, Baclayon,
Bohol, Philippines;

5. That despite diligent effort to find it, but the same could not be found;

6. That there is a reasonable ground to believe that the same could no longer be recovered;

7. That the aforementioned high school handbook is not in the hands of any third person or
person of authority for value or consideration;

8. That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

ROSEMARIE REAL BADE

Affiant

Signed in the presence of:

 _________________________ ______________________

SUBSCRIBED AND SWORN to before me this ________ day of _______________________ at the

City of Tagbilaran, Philippines, by the affiant with her Identification Card No. __________________
issued on _______________________ by the Philippine Regulation Commission (PRC) as registered
teacher .

Republic of the Philippines )

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, GAUDIOSO L. CARIDO, Filipino, of legal age, married and a resident of Bilar, Bohol,
Philippines, after being duly sworn to in accordance with law, herby depose and say:

1. That I am a holder of an original contract of a life insurance of Philam;

2. That the original contract of Philam life insurance was in my possession and custody;

3. That the said original contract of Philam life insurance was inadvertently misplaced and
eventually got lost at home in Bilar, Bohol, Philippines;

4. That despite diligent effort to find it, but the same could not be found;

5. That there is a reasonable ground to believe that the same could no longer be
recovered;

6. That the aforementioned original contract of Philam life insurance is not in the hands of
any third person or person of authority for value or consideration;

7. That 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 ______ day of

________________________ at the City of Tagbilaran, Philippines.

GAUDIOSO L. CARIDO
Affiant

Signed in the presence of:

 ______________________ ______________________

SUBSCRIBED AND SWORN to before me this ________ day of

_______________________ at the City of Tagbilaran, Philippines, by the affiant with his CTC/ID
No. ____________ issued on ______________ issued by/in _____________________________.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2016.