Republic of the Philippines )

City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, RENATO C. SINGIAN, JR., Filipino, of legal age and a resident of 477 Looban St.,
Del Pilar, City of San Fernando, Pampanga, after having been sworn in accordance with
law, hereby depose and state:

1. That I am a holder of an Official Receipt with No. 0066820D issued to me dated

November 20, 2018 by MTCC- City of San Fernando, Pampanga amounting to
Php3,000.00 which serves as my cash deposit for CC #18-0991;

2. That on June 2, 2019, said Official receipt was lost while I was at the vicinity of
City of San Fernando, Pampanga and the same could no longer be found;

3. That I hereby declare and attest that said Official Receipt as lost;

4. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

RENATO C. SINGIAN, JR.

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, ARLEE P. BALINGIT, Filipino, of legal age and a resident of 431 Sta. Cruz, Parian,
Mexico, Pampanga, after having been sworn in accordance with law, hereby depose and
state:

5. That I am a holder of Official Receipts with Nos. 876055 and 564123 which serves
as my payment for contribution in Social Security System (SSS) - (May 2003);

6. That sometime in 2003, said Official receipts were lost and/or misplaced among my
files at home and the same could no longer be found;

7. That I hereby declare and attest that said Official Receipts as lost;

8. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

ARLEE P. BALINGIT
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, ERMENILDA C. DUNGLAO, Filipino, of legal age and a resident of Blk. 5, Lot 18,
Babmboo St., Park Place, Pueblo de Ordo, Del Carmen, City of San Fernando,
Pampanga, after having been sworn in accordance with law, hereby depose and state:

9. That I am the wife of JESUS D. DUNGLAO, who is a holder of an Official Receipt

with No. BC0982 which serves as his payment for his membership in Social
Security System (SSS) - (July to September 2019);

10. That sometime in July 2019, said Official receipt was lost and/or misplaced among
my files at home and the same could no longer be found;

11. That I hereby declare and attest that said Official Receipt as lost;

12. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

ERMENILDA C. DUNGLAO
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, IVY B. RIVERA, Filipino, of legal age, authorized representative of CORTES

TRADING, Wholesale and Retail, with office address at Gen. Hizon Ave., City of San
Fernando, Pampanga, after having been sworn in accordance with law, hereby depose
and state:

13. That on January 4, 2019, I issued an Official Receipt to the Local Government Unit
of San Fernando, Pampanga amounting to Twenty Five Thousand Pesos
(Php25,000.00) as payment for the purchase of 1.5HP Goulds Vertical Pump;

14. That I was informed that said Official receipt got lost and/or misplaced and the
same could no longer be found;

15. That on June 3, 2019, I certified a photocopy of the said Official Receipt as proof
that I issued the same;

16. That I hereby declare and attest that said Official Receipt was lost and I certified
said copy;

17. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

IVY B. RIVERA
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, ARIES D. GOZUN, Filipino, of legal age, and a resident of San Pedro, City of San
Fernando, Pampanga, after having been sworn in accordance with law, hereby depose
and state:

18. That I an employee of JT International (Philippines) Inc., located at Parkbridge,

Mexico Gold, Lagundi, Mexico, Pampanga;

19. That I am the liable person to keep the yellow duplicate of the collection receipt
with no. 0263079 dated June 19, 2019 issued to AILEEN MORALES;

20. That on June 19, 2019, the yellow duplicate of the collection receipt was lost while
I was at the vicinity of City of San Fernando, Pampanga and the same could no
longer be found;

21. That diligent effort exerted to locate and recover the aforesaid yellow duplicate of
the collection receipt proved futile;

22. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

ARIES D. GOZUN
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, ELEAZARETH A. VALENZUELA, Filipino, of legal age, and a resident of Blk 79

Lot 18, Northville 14, Calulut, City of San Fernando, Pampanga, after having been sworn
in accordance with law, hereby depose and state:

23. That I am the registered owner of Printstop Printing Services located at Blk 13 Lot
19, Davsan Subd., Sindalan, City of San Fernando, Pampanga;

24. That on March 20, 2019, the Official Receipt Booklet of Printstop Printing Services
with Control Nos. 101-150 was lost and/ or misplaced and the same could no longer
be found;

25. That diligent effort exerted to locate and recover the aforesaid Official Receipt
Booklet proved futile;

26. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

ELEAZARETH A. VALENZUELA
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, ANGELO JOHN S. CASTRO, Filipino, of legal age, and a resident of Blk. 58, Lot
23, Northville 14, Calulut, City of San Fernando, Pampanga, after having been sworn in
accordance with law, hereby depose and state:

27. That I am an employee of Frabelle Corporation designated as Distributor

Specialist;

28. That our company issued a Collection Receipt with No. 08083, Invoice No.
0087673-0087675 in the amount of Php 434,617.17 to MOR Enterprises;

29. That sometime in year 2018, said Counter Receipt was lost and/ or misplaced and
the same could no longer be found;

30. That diligent effort exerted to locate and recover the aforesaid Counter Receipt
proved futile;

31. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

ANGELO JOHN S. CASTRO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, JOVEN M. USI, Filipino, of legal age, and a resident of Bagang, Masantol,

Pampanga, after having been sworn in accordance with law, hereby depose and state:

32. That I am an employee of ACS Manufacturing Corporation, Via Valle Warehouse

Brgy. Baliti, City of San Fernando, Pampanga designated as Sales Representative;

33. That I am the liable person for the sales invoice dated September 28, 2018 with nos.
0043010 and 0043011 issued by our company to A.A. Saver’s Mart-Pampanga,
Tiomico St., San Fernando, Pampanga amounting to Php67,745.54 and
Php63,553.22 respectively;

34. That on October 10, 2018, said sales invoice were lost and/ or misplaced and the
same could no longer be found;

35. That diligent effort exerted to locate and recover the aforesaid sales invoice proved
futile;

36. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

JOVEN M. USI
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, ELEAZAR R. PAMINTUAN, Filipino, of legal age, and a resident of57 Purok 2,

Magliman, City of San Fernando, Pampanga, after having been sworn in accordance with
law, hereby depose and state:

37. That I am a holder of a Sales Invoice issued to JOSE B. LINGAD MEMORIAL

REGIONAL HOSPITAL by RG Meditron, Inc. with S.I. No. 166724;

38. That sometime in January 2019, said sales invoice was lost and/ or misplaced and
the same could no longer be found;

39. That I hereby declare and attest said sales invoice as lost;

40. That diligent effort exerted to locate and recover the aforesaid sales invoice proved
futile;

41. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

ELEAZAR R. PAMINTUAN
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, LIEZEL M. GALURA, Filipino, of legal age, and a resident of Del Pilar, City of San
Fernando, Pampanga, after having been sworn in accordance with law, hereby depose
and state:

42. That I am an employee of SF Junfel Marketing for which I am the accountable

person to collect such Counter Receipt #52702 issued to BuyMaxx, Sta. Rita,
Pampanga Branch;

43. That sometime in July 2018, said counter receipt was lost and/ or misplaced and the
same could no longer be found;

44. That I hereby declare and attest said counter receipt as lost;

45. That diligent effort exerted to locate and recover the aforesaid counter receipt
proved futile;

46. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

LIEZEL M. GALURA
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2019
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, LARA JHILLE C. CARLOS, Filipino, of legal age, single and a resident of

Capalangan, Apalit, Pampanga, after having been sworn in accordance with law, hereby
depose and state:

47. That I am an employee of S&R Membership Shopping for which I am the

accountable person to keep the Garbage Haul official receipt issued by Card Ways
Houling;

48. That on July 5, 2018, said official receipt was lost and/ or misplaced and the same
could no longer be found;

49. That I hereby declare and attest said official receipt as lost;

50. That diligent effort exerted to locate and recover the aforesaid official receipt
proved futile;

51. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

LARA JHILLE C. CARLOS

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2018
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, MARIO C. MELLA, Filipino, of legal age, single and a resident of Brgy. San Roque,
Banban, Tarlac, after having been sworn in accordance with law, hereby depose and
state:

52. That I am an employee of Royal Mandarin Security Service Corporation (Armor

Transport Plus) designated as Area Supervisor;

53. That our former driver is the holder of a Motolite Car Battery Warranty Card issued
by Motolite purchased by our company;

54. That said Warranty Card was lost and/ or misplaced and the same could no longer
be found;

55. That as the representative of our company, I hereby declare said Warranty Card as
lost;

56. That diligent effort exerted to locate and recover the aforesaid Warranty Card
proved futile;

57. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

MARIO C. MELLA
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2018
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, MARLON M. REYES, Filipino, of legal age, single and a resident of Dolores, City of
San Fernando, Pampanga, after having been sworn in accordance with law, hereby
depose and state:

58. That I am the owner of MARLON REYES ENTERPRISES for which I issued a
Delivery Receipt with no. 338 2009 amounting to P1,615.95 to K and J Pharmacy
located at Bataan;

59. That sometime in June 2018, said Delivery Receipt was lost and/ misplaced and the
same could no longer be found;

60. That diligent effort exerted to locate and recover the aforesaid Delivery Receipt
proved futile;

61. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this

_____________________ at the City of San Fernando, Pampanga.

MARLON M. REYES
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2018
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, KEVIN TANMAJO MEDINA, Filipino, of legal age, single and a resident of Ibaba,
Samal, Bataan, after having been sworn in accordance with law, hereby depose and state:

62. That I am an employee of Excite Touchpoint, designated as Brand Account

Assistant;

63. That on March 2, 2015, RNCJ Design and Print issued an Official Receipt No. 0500
in the name of our company, Excite Touchpoint in the amount of P225,000.00;

64. That the original copy of the said delivery receipt was lost and/or misplaced and the
same could no longer be found;

65. That diligent effort exerted to locate and recover the aforesaid delivery receipt
proved futile;

66. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this 23 rd day of

February 2016 at the City of San Fernando, Pampanga.

KEVIN TANMAJO MEDINA

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.

Doc No.
Page No.
Book No.
Series of 2016
0
Republic of the Philippines )
City of San Fernando, Pampanga )SS

AFFIDAVIT OF LOSS

I, RIZA NAVA, Filipino, of legal age, married and a resident of No. 57 Sitio 10 Sto.
Niño, City of San Fernando, Pampanga, after having been sworn in accordance with law,
hereby depose and state:

1. That I am an employee of Linkage Foods Venture Corp., designated as Key

Account Manager;

2. That on December 03, 2015, our company (Linkage Foods) issued a Delivery
Receipt No. INV-04548 in the name of 7’S Buan Supermarket Inc., Poblacion, JM
Espino St., Arayat, Pampanga in the total amount of P9,103.85;

3. That the original copy of the said delivery receipt was lost and/or misplaced and the
same could no longer be found;

4. That diligent effort exerted to locate and recover the aforesaid delivery receipt
proved futile;

5. That I am executing this affidavit to attest the veracity of the foregoing and for
whatever legal intent and purposes this may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this 23 rd day of

February 2016 at the City of San Fernando, Pampanga.

RIZA NAVA
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and place stated above.
Doc No.
Page No.
Book No.
Series of 2016

Republic of the Philippines )

Province of Pampanga ) S.S
City of San Fernando )

AFFIDAVIT OF LOSS

I, LEONORA B. RUEDA, Filipino, of legal age, married and a resident of Sucad, Apalit,
Pampanga, after having been sworn in accordance with law do hereby depose and state:

1. I am connected with Boardwalk Business Ventures as Junior Marketing

Consultant.

2. Sometime in July 2008, the cash bond receipts issued to Ms. Mary Jane T.
Pasamba and Marites C. Bayani, both dealers of Boardwalk were lost. They were
misplaced from my files.

3. Diligent effort was exerted to ascertain the whereabouts of the lost cash bond
receipts but to no avail;

4. I am executing this affidavit to attest the veracity of the foregoing facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I am affixing my signature hereto on this 3rd day of

September 2008 at City of San Fernando, Pampanga.

LEONORA B. RUEDA
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this 3rd day of September 2008 at City
of San Fernando, Pampanga, affiant exhibiting his Community Tax Certificate No.
19701390 issued on March 29, 2008 at Apalit, Pampanga

Doc No.
Page No.
Book No.
Series of 2008