Republic of the Philippines)

City of Legazpi ) s.s.

x-------------------------------------------x

AFFIDAVIT OF LOSS

I, GERALDO B. YANZON, of legal age, Filipino citizen, single and with residence
and postal address at Balogo, Oas, Albay, after having been duly sworn in accordance
with law do hereby depose and state:

1. That I am a teacher by profession assigned at Pantao National High School

at Libon, Albay;

2. That a Certificate of Board Rating was issued to me by Civil Service

Commission Region V sometime in 1998;

3. That I am planning to transfer to another school. One of the requirements

of which is the submission of Certificate of Board Rating;

4. However, when I try to look for the said certificate, the same can no longer
be located despite diligent efforts made and considered lost;

5. That I am executing this affidavit to attest the truth of the foregoing

statements and for the purpose of reissuance of the said Certificate with
the Civil Service Commission.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of November,
2016 at Legazpi City, Philippines.

GERALDO B. YANZON
Affiant
PRC ID No. 0268083

SUBSCRIBED AND SWORN to before me this 15th day of November 2016 at

Legazpi City, Philippines, affiant exhibited himself to me his Professional Regulation
Commission Identification Card bearing his photograph and genuine signature as
competent proof of his identity pursuant to the 2004 Rules on Notarial Practice.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2016.