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AFFIDAVIT OF LOSS
I, Jan Lloyd B. Oja, of legal age, Filipino, single, and a resident of Caridad Sur, Matalom, Leyte, after
having been sworn in accordance with law, hereby deposes and states the following:
SUBSCRIBED AND SWORN TO before me, a notary public in and for Cebu City this ____ of _________,
2018. The affiant, whom I identified through the following competent evidence of identity: School
ID No. 1090626, issued by University of Visayas, personally signed the foregoing instrument before
me and vowed under penalty of law to the whole truth of the contents of said instrument.
Notary Public