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Affidavit of Loss

Romel L. Sitenta filed an affidavit of loss stating that (1) he is the registered holder of a Form 138 report card issued by Generoso National High School but that (2) the report card was missing and he does not know how or where it was lost. He (3) asserts that he made efforts to find the lost report card but was unsuccessful, so he is filing this affidavit to request re-issuance of the Form 138.

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Rowena Melitado Doria
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1K views1 page

Affidavit of Loss

Romel L. Sitenta filed an affidavit of loss stating that (1) he is the registered holder of a Form 138 report card issued by Generoso National High School but that (2) the report card was missing and he does not know how or where it was lost. He (3) asserts that he made efforts to find the lost report card but was unsuccessful, so he is filing this affidavit to request re-issuance of the Form 138.

Uploaded by

Rowena Melitado Doria
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

CITY OF BACOLOD ) S.S

X . X

AFFIDAVIT OF LOSS

I, ROMEL L. SITENTA, Filipino Citizen , legal age and a resident of Gerald Compound , Villa
Soledad Subd. , Brgy . Estefania, Bacolod City, Philippines, under oath solemnly states;

1. That I am the registered holder of Form 138 (Report Card) duly issued by Generoso National High
School,

2. That the said Form 138 was missing which I could not as certain how and where;

3. That I could just speculate that it was inadvertently lost for all intent and purposes;

4. That I exerted all my efforts in order to find and locate it, but of no avail;

5. That I am executing this sworn statement to attest to the veracity of the above statement to request
the re issuance of the Form 138.

IN WITNESS WHEREOF I HAVE HEREUNTO affixed signature this _________ day of ________,

2017 in the City of Bacolod, Philippines.

ROMEL L. SITENTA

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _______________ day of _________________,


2017 in the City of Bacolod, Negros Occidental, Philippines.

Doc. No. : ___________

Page No. : ___________

Book No. : ___________

Series of 20 __________

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