REPUBLIC OF THE PHILIPPINES)

LAS PIAS CITY

)S.S.

AFFIDAVIT OF LOSS
I, ROMY C. CALANTOC, of legal age, Filipino, and resident of #11 Onelia
Jose St., BF Resort Village, Las Pinas City, after being duly sworn to in accordance
with law, hereby depose and say that:
I am a holder and owner of the following training certificates issued by
different training centers, as follows:
a) Oily Water Separator Course
b) Chemical and Product Tanker Simulation Course
c) Ship Security Awareness Training and Seafarers with Designated Security
Duties with COP ORNAC
d) Lathe Machine Course
e) Engine Watchkeeping Course
f) Training Record Book for Marine Engineering
g) Seafarers Registration Certificate (SRC)
On August 9, 2014, at bus Terminal in Pasay City, my bag containing all the
aforesaid training certificates and other personal belongings was lost.
Inspite of diligent search efforts to look for my said bag containing all the
aforesaid training certifcates, all such efforts proved futile and in vain, thus, I am
now declaring the loss of all my training certificates.
I am executing this affidavit to attest to the truth of the foregoing facts and
for all its legal intents, effects, consequences and purposes, including for the
issuance to me of another training certificates in lieu of the ones that were lost.

ROMY C. CALANTOC
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this September 13, 2014 at

Las Pias City, affiant with his identification card of:
Doc. No. 81
Page No. 18
Book No. 87
Series of 2014.

REPUBLIC OF THE PHILIPPINES)

LAS PIAS CITY
)S.S.

AFFIDAVIT OF LOSS
I, HERMINIGILDO M. ROXAS, of legal age, Filipino, married and resident of
Block 59B Lot 27 D, Via Ancelle Del Immacolta St., BF Resort Village, Las Pinas City,
after being duly sworn to in accordance with law, hereby depose and say that:
1.

A Universal Robina Corporation (URC) stock Certificate numbered 34361

was issued to me by URC on July 27, 2001 for Four Hundred Twenty (420) shares.
2.

The aforesaid Stock Certificate No. 34361 was lost by the affiant nor that

he parted with it under fraudulent or unlawful means.

3.

Affiant has exerted diligent effort to locate the said Stock Certificate, but

to no avail.
4.

I am executing this affidavit to attest to the truth of the foregoing facts

and for all its legal intents, effects, consequences and purposes, including for the
issuance to me of another Stock Certificate in lieu of the one lost.

HERMINIGILDO M. ROXAS
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this June 19, 2013 at Las
Pias City, affiant with his residence certificate no.06116710 issued on January 31,
2013 at Las Pinas City.
Doc. No.

448

Page No.

91

Book No.

70

Series of 2013

REPUBLIC OF THE PHILIPPINES)

LAS PIAS CITY

)S.S.

AFFIDAVIT OF LOSS
I, ZEPHANIAH BLANCA C. ABAD, of legal age, Filipino, single and resident of
#104 P. Maliksi II, Bacoor, Cavite, after being duly sworn to in accordance with law,
hereby depose and say that:
5.
no.

I am a holder and owner of company identification card with employee

100336765

issued by my employer CONVERGYS with office address at

Alabang, Muntinlupa City.

2. My said company identification card was lost.
3. Inspite of diligent efforts to look for said company identification card all
such efforts proved futile and in vain up to this time, thus, I am declaring the loss
of the said company identification card.
4.

I am executing this affidavit to attest to the truth of the foregoing facts

and for all its legal intents, effects, consequences and purposes, including for the
issuance to me of another company identification card

in lieu of the one that was

lost.

ZEPHANIAH BLANCA C. ABAD

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this July 2, 2012 at Las Pias
City.
Doc. No.

212

Page No.

43

Book No.

58

Series of 2012