Affidavit of Loss

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Republic of the Philippines

Province of Albay
Municipality of Oas
BARANGAY CALPI

OFFICE OF THE SANGGUNIANG BARANGAY

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that LINDON O. BARQUIN, single, a bonafide resident


of Purok 3, Calpi, Oas, Albay.

This certification being issued upon request of the above interested party for
the loss of Form 138.

Issued this 21st day of July 2021 at Barangay Calpi, Oas, Albay

NOTE: THE BARANGAY HAS NO DRY SEAL

Certified by:

VILMA A. RENTORIA
Punong Barangay

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