Republic of the Philippines ) Province of Tarlac ) s.s x - - - - - - - - - - - - - - - - - - - - - x
AFFIDAVIT OF LOSS
I,
JOCELYN SERNA,
Filipino, of legal age and a presently residing at Phase 2, Camella Homes, Tarlac City, after having been duly sworn to in accordance with law, hereby depose and state, that: 1. Because of the construction at my house at Camella Homes, I furnished a construction bond amounting to
T HIRTY THOUSAND PESOS (P30,000.00)
; 2. Said bond are evidenced by official receipts bearing the numbers:
0014566
and
0014567
; 3. I was keeping the said receipts in my residence mentioned above; 4. Recently, while I was preparing my documents for the release of the said bonds, I discovered that the original copies of the said receipts are missing. I exerted reasonable effort to locate the receipts, but to no avail, and I am now considering said receipts as lost and beyond recovery; 5. I am executing this instrument to attest the foregoing and for other legal intent and purpose. END OF AFFIDAVIT. IN WITNESS WHEREOF, I hereby affix my signature this __________ in __________.
JOCELYN SERNA
Affiant
I.D. __________________ ______________________ SUBSCRIBED AND SWORN to before me this ___________ in ____________ affiant personally appeared exhibiting her competent evidence of identity provided above. Doc. No. _____; Page No. _____; Book No. _____; Series of 2018