Republic of the Philippines ) Camiling, Tarlac ) S.S.
AFFIDAVIT OF LOSS
I, NICK JOHN AGUSTIN y GALAPON, 20 years old, ilipino citi!en, single and a resident of "arangay #e$ Salem, %erona, Tarlac, after ha&ing been s$orn to in accordance $ith la$, do hereby depose and state THAT' (. I $as $as issu issued ed by the the Techni chnica call duc ducat atio ion n S*il S*ills ls +e&e e&elopm lopmen entt utho u thorit rity y -TS+ -TS+) ) a TS+ TS+ n nima imall Produc Productio tion n #C II Certi Certific ficate ate after completing the reuired program sometime in 20(/ at the Tarlac College of griculture, Camiling, Tarlac 2. I *ept *ept the sa said id #C II certifi certificat cate, e, togethe togetherr $ith $ith my other other person personal al documents, in one of the dra$ers inside my room 1. ately, ately, $hile I $as organi!ing organi!ing my personal personal effects, I disco&ered disco&ered that the abo&e3said certificate $as missing /. I immediatel immediately y searched searched the said certific certificate ate in the other other dra$ers dra$ers in our house but I found nothing. I also as*ed the members of our household if they ha&e found the same but all ans$ered in the negati&e 4. ll ll my dili dilige gent nt effo effort rts s e5er e5erte ted d to loca locate te the the sa said id TS+ TS+ n nim imal al Production #C II certificate pro&ed futile hence, I no$ consider the same as lost and beyond reco&ery 6. I am e5ecuting e5ecuting this this affida&it affida&it to attest to the truth truth of the foregoing foregoing statements and for all legal intents and purposes it may ser&e. I ha&e hereunto set my hand this 22 nd day of ebruary, 20(6 at Camiling, Tarlac, Philippines. IN WITNESS WHEREOF ,
NICK JOHN G. AGUSTIN
ffiant SUBSCRIBED SUBSCRIBED AND SWORN to
before me on the date and place indicated abo&e. ffiant e5hibited before me his School Identification Card $ith $ith St Stud uden entt #umb #umber er 20(2 20(2(0 (000 0062 62 issu issued ed by the the Tarlac rlac Coll Colleg ege e of griculture, Camiling, Tarlac.
Doc. No. _____; Page No. _____; Book No. _____; Series of 2016.
