Affidavit of Loss Tor

REPUBLIC OF THE PHILIPPINES}
DOLORES, EASTERN SAMAR } S.S.

x- - - - - - - - - - - - - - - - - - - - - - - - - - -x
AFFIDAVIT OF LOSS
I, MARGIE LYN RODELES ROBREDILLO, of legal age, single, Filipino and a

resident of Barangay 12, Dolores, Eastern Samar, after having been duly sworn to in
accordance with law, do hereby deposes and states:
1. That I am an undergraduate student of Eastern Samar State

University main campus, Borongan City, Eastern Samar, for Bachelor of
Science in Tourism last August 2018 to December 2018;
2. That after the said semestral period, I decided to transfer to

Eastern Samar State University can-avid campus, Can-avid, Eastern
Samar;
3. That I personally secured a copy of my Original Transcript of

Records issued by the Registrar’s Office of Eastern Samar State
University main campus sometime in the year 2018;
4. That the said copy of my Original Transcript of Records

was not already in my files where I used to placed it, and despite diligent
efforts to locate it, the same could not be found and beyond recovery;
5. That I am requesting the Registrar’s Office of Eastern Samar

State University, for another copy of my Original Transcript of Records
pertaining to my intention to continue my studies.
IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of May,

2023 at Dolores, Eastern Samar.
MARGIE LYN RODELES ROBREDILLO

Affiant
TIN: 606-436-087-00000
SUBSCRIBED AND SWORN to before me this 29th day of May 2023 at Dolores,
Eastern Samar.
Doc. No. ____

Page No. ____
Book No. ____
Series of 2023
Doc. No. ____
Page No. ____
Book No. ____
Series of 2023

SANTIAGO C I T Y}: S.S.
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AFFIDAVIT OF LOSS
I, JUN JUN SEDICO,of legal age, married, Filipino, and a resident of Brgy.Gud,
San Isidro, Isabela, after having been duly sworn to in accordance with law, do hereby
depose and state:
1. That I am the holder ofan OFFICIAL RECEIPT issued bythe Land

Transportation Office (LTO), Santiago City;
2. That said OFFICIAL RECEIPT was accidentally lost sometime on

September 2013 at San Isidro, Isabela, and despite diligent efforts to
locate it, the same could not be found and is now beyond recovery;
3. That I am executing this affidavit to attest to the fact of loss of said

OFFICIAL RECEIPT and to inform the LTO-Santiago City and to request
further for the renewal of my Driver’s License even without the said Official
Receipt;
IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of March,
2014 at Santiago City.
JUN JUN P. SEDICO

Affiant
License ID No.B06-086-000317
SUBSCRIBED AND SWORN to before me this 7 th day of March, 2014 at

Santiago City.
Doc. No. ____

Page No. ____
Book No. ____
Series of 2014

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AFFIDAVIT OF LOSS
I, REYGHIE S. PANTALEON,of legal age, single, Filipino and a resident of

District 4, San Manuel, Isabela, after having been duly sworn to in accordance with law,
do hereby deposes and states:
1. That I am the holder of Permit for Examination issued byAMA Campus,

Santiago City;
2. That said PERMIT was accidentally lost sometime last month of

January, 2013 at Santiago City, and despite diligent efforts to locate it, the
same could not be found and beyond recovery;
3. That I am executing this affidavit to attest into the fact of loss of said
PERMIT and to inform the AMA Campus, Santiago City;
IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of February,
REYGHIE S. PANTALEON
Affiant
Philhealth ID No. 06-050076335-6
SUBSCRIBED AND SWORN to before me this 1st day of February, 2013 at

Santiago City.
Doc. No. ____

Page No. ____
Book No. ____
Series of 2013

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AFFIDAVIT OF LOSS
I, JERRY F. URBANO, of legal age, married, Filipino and a resident of

Barangay Doña Paulina, San Isidro, Isabela, after having been duly sworn to in
1. That I am the holder of PROVISIONAL RECEIPT No. 002162 and

002170, issued by Manulife, Santiago City Branch, Santiago City;
2. That said PROVISIONAL RECEIPT was accidentally lost sometime last

month of January, 2013 at Santiago City, and despite diligent efforts to
locate it, the same could not be found and beyond recovery;
PROVISIONAL RECEIPT and to inform the Manulife, Santiago City
Branch, Santiago City;
IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of February,
JERRY F. URBANO
Affiant
SUBSCRIBED AND SWORN to before me this 11th day of February, 2013 at

Santiago City.
Doc No._____
Page No. _____
Book No._____
Series of 2013

x---------------------------------------------x
AFFIDAVIT OF LOSS
I, ANNA FLORABEL N. AYROSO, of legal age, single, Filipino citizen and

a resident of Christine Village, Cauayan City, after having been duly sworn to in
1. That I am the holder of SIM CARD No. 09359033158;
2. That said SIM CARD was accidentally lost sometime this month of
January, 2011 at Cauayan City, and despite diligent efforts to locate it,
the same could not be found and beyond recovery;
3. That I am executing this affidavit to attest into the fact of loss of said SIM
CARD;
IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of January,

ANNA FLORABEL N. AYROSO

Affiant
SSS No. 01-2030309-80

Issued at: Cauayan City
SUBSCRIBED AND SWORN to before me this 28th day of January, 2011 at

Santiago City.
Doc No._____
Page No. _____
Book No.59
Series of 2011

x---------------------------------------------x
AFFIDAVIT OF LOSS
I, FE DUMALIANG FLORENTIN, of legal age, married, Filipino citizen and a

resident of Barangay Camarag, San Isidro, Isabela, after having been duly sworn to in
1. That I am the agent of Manulife Manufacturers Life Insurance, Branch

Office, Santiago City;
2. That said PROVISIONAL RECEIPT was accidentally lost sometime

last month of February, 2011 at Santiago City, and despite diligent efforts
to locate it, the same could not be found and beyond recovery;
PROVISIONAL RECEIPT and to inform the Manulife Head Office, Makati
City;
IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of May,
FE DUMALIANG FLORENTIN
Affiant
Dri.Lic. ID No. B12-09-001720

Issued at: Santiago City
Until: 02-23-12
SUBSCRIBED AND SWORN to before me this 26th day of May, 2011 at

Santiago City.
Doc No._____
Page No. _____
Book No. _____
Series of 2011

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AFFIDAVIT OF LOSS
I, MARITA M. TUMAMAO,of legal age, married, Filipino and a resident of

Barangay Gomez, San Isidro, Isabela, after having been duly sworn to in accordance
with law, do hereby deposes and states:
1. That I am the holder of PREFARRED SHARES (PS) No. 13755, issued

by Fico Bank, Santiago City Branch, Santiago City;
2. That said PREFARRED SHARES was accidentally lost sometime last

year, 2011 at San Isidro, Isabela, and despite diligent efforts to locate it,
the same could not be found and beyond recovery;
PREFARRED SHARES and to inform the Fico Bank, Santiago City
Branch, Santiago City;
IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of May,
MARITA M. TUMAMAO
Affiant
Postal Id No. 9622372

Valid Until: August, 2013
SUBSCRIBED AND SWORN to before me this 30th day of May, 2012 at

Santiago City.
Doc No._____
Page No. _____
Book No._____
Series of 2012

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REPUBLIC OF THE PHILIPPINES}

DOLORES, EASTERN SAMAR } S.S.

I, MARGIE LYN RODELES ROBREDILLO, of legal age, single, Filipino and a

1. That I am an undergraduate student of Eastern Samar State

2. That after the said semestral period, I decided to transfer to

3. That I personally secured a copy of my Original Transcript of

4. That the said copy of my Original Transcript of Records

5. That I am requesting the Registrar’s Office of Eastern Samar

IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of May,

MARGIE LYN RODELES ROBREDILLO

Doc. No. ____

REPUBLIC OF THE PHILIPPINES}

1. That I am the holder ofan OFFICIAL RECEIPT issued bythe Land

2. That said OFFICIAL RECEIPT was accidentally lost sometime on

3. That I am executing this affidavit to attest to the fact of loss of said

JUN JUN P. SEDICO

SUBSCRIBED AND SWORN to before me this 7 th day of March, 2014 at

Doc. No. ____

REPUBLIC OF THE PHILIPPINES}

I, REYGHIE S. PANTALEON,of legal age, single, Filipino and a resident of

1. That I am the holder of Permit for Examination issued byAMA Campus,

2. That said PERMIT was accidentally lost sometime last month of

SUBSCRIBED AND SWORN to before me this 1st day of February, 2013 at

Doc. No. ____

REPUBLIC OF THE PHILIPPINES}

I, JERRY F. URBANO, of legal age, married, Filipino and a resident of

1. That I am the holder of PROVISIONAL RECEIPT No. 002162 and

2. That said PROVISIONAL RECEIPT was accidentally lost sometime last

SUBSCRIBED AND SWORN to before me this 11th day of February, 2013 at

REPUBLIC OF THE PHILIPPINES}

I, ANNA FLORABEL N. AYROSO, of legal age, single, Filipino citizen and

1. That I am the holder of SIM CARD No. 09359033158;

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of January,

ANNA FLORABEL N. AYROSO

SSS No. 01-2030309-80

SUBSCRIBED AND SWORN to before me this 28th day of January, 2011 at

REPUBLIC OF THE PHILIPPINES}

I, FE DUMALIANG FLORENTIN, of legal age, married, Filipino citizen and a

1. That I am the agent of Manulife Manufacturers Life Insurance, Branch

2. That said PROVISIONAL RECEIPT was accidentally lost sometime

Dri.Lic. ID No. B12-09-001720

SUBSCRIBED AND SWORN to before me this 26th day of May, 2011 at

REPUBLIC OF THE PHILIPPINES}

I, MARITA M. TUMAMAO,of legal age, married, Filipino and a resident of

1. That I am the holder of PREFARRED SHARES (PS) No. 13755, issued

2. That said PREFARRED SHARES was accidentally lost sometime last

Postal Id No. 9622372

SUBSCRIBED AND SWORN to before me this 30th day of May, 2012 at

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