Republic of the Philippines )

Province of Sorsogon ) S.S.

Municipality of Bulan )

AFFIDAVIT OF LOSS

I, ROLAND TAN GIGANTONE, of legal age, Filipino, married and a resident of

Zone 8, Bulan, Sorsogon, after being duly sworn according to law, do hereby depose and
state:

1. That I am one of those who passed the Police Officer I entrance examination
conducted by the Civil Service Commission sometime on July 1996;

2. That by virtue thereof I was issued with Certificate of Eligibility by the CSC;

3. That unfortunately on December 14, 2015 while Typhoon Nona struck the
Municipality of Bulan, our house was one of those partially destroyed and on its
aftermath said Certificate of Eligibilty got missing among my files at our residence;

4. That despite my diligent efforts to locate the same, it proved futile thus I am
considering it lost forever;

5. That I have freely executed this affidavit to attest to the foregoing facts and for the
purpose of reissuance in lieu of the lost one before the Civil Service Commission;

IN WITNESS WHEREOF, I have hereunto signed my name below, this 21st day of
November 2016 at Bulan, Sorsogon.

ROLAND TAN GIGANTONE

Affiant

SUBSCRIBED AND SWORN TO before me, this 21st day of November 2016 at
Bulan, Sorsogon by affiant who exhibited to me his UMID Card with No. 006-0127-1071-9.

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Page No._____;
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Series of 2016.