REPUBLIC OF THE PHILIPPINES)

CITY OF KABANKALAN ) S.S.

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

AFFIDAVIT OF LOSS

I, __________________________________________, of legal age, single/married, Filipino

Citizen and a resident of __________________________________________________, Negros
Occidental, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and say:

That I am a holder of _____________________________________________ duly issued by

the __________________________________________.

That the said _____________________________________ was lost in my possession and

its whereabouts could not be ascertained despite diligent efforts having been exerted.

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

statements and to request the agency/office concerned to issue a new
______________________________________ in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________,

2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________________________
(Signature over printed name)
Affiant
ID NO. __________________________
CTC No. ________________________
Issued at. _______________________
Issued on. ______________________

SUBSCRIBED AND SWORN to before me this _________________________, 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESES PRESENTS:

I, ____________________________________, of legal age, single/married, Filipino Citizen and a

resident of __________________________________________, Kabankalan City, Negros Occidental,
Philippines, by these presents, hereby name, constitute and appoint
____________________________________, , of legal age, married/single, Filipino and resident of
___________________________________________, to be my true and lawful Attorney-in-Fact for me and
my name, place and stead to do and perform the following things and act, to wit:

1. __________________________________________________________________________________________
__________________________________________________________________________________________
_____________________________________________________________;
2. ________________________________________________________________________________;

HEREBY GIVING AND GRANTING unto said Attorney-in-Fact full power and authority
to do and perform all and every act requisite or necessary to carry into effect the foregoing
authority as fully to all intents and purposes as I might or could lawfully do if personally present,
and hereby ratifying and confirming all that my said attorney-in-fact shall lawfully do or cause to
be done by virtue hereof.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________, 2017 at

Kabankalan City, Negros Occidental, Philippines.

_________________________________ ________________________________
Principal Attorney-In-Fact

WITNESSES:

1. ____________________ 2. _____________________________

ACKNOWLEDGEMENT

BEFORE ME, this ____________ day of _____________________, 2017 in the City of

Kabanakalan, personally appeared ____________________________________ with Community Tax
Certificate No. ____________________________________ issued at _____________________ issued on
__________________, Philippines, known to me and to me known to be the same person who
executed the foregoing documents and that he\she acknowledged to me that the same is
his/her own free and voluntary act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________, 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

AFFIDAVIT OF DISCREPANCY

I, __________________________________________, ______ years old, single/married,

Filipino Citizen and a resident of __________________________________________________, Negros
Occidental, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and say:

That my true and correct ________________________________________________ is

__________________________________________________________________;

That however, my ____________________________________ was erroneously recorded as

______________________________________ in my _______________________________________;

That the discrepancy was not intentional;

That _____________________________________ and ______________________________________

refer to one and the same person.

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

statements and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________,

2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________________________
(Signature over printed name)
Affiant
ID NO. __________________________
CTC No. ________________________
Issued at. _______________________
Issued on. ______________________

SUBSCRIBED AND SWORN to before me this _________________________, 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

AFFIDAVIT OF NON-EMPLOYMENT

I, __________________________________________, ______ years old, single/married,

Filipino Citizen and a resident of __________________________________________________, Negros
Occidental, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and say:

That since ___________ up to the present I have not been employed at any business
establishment or by any person or entity;

That I have no pending case before any court, judicial or quasi-judicial body;.

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

statements and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________,

2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________________________
(Signature over printed name)
Affiant
ID NO. __________________________
CTC No. ________________________
Issued at. _______________________
Issued on. ______________________

SUBSCRIBED AND SWORN to before me this _________________________, 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

JOINT AFFIDAVIT OF TWO (2) DISINTERESTED PERSONS

We, _______________________________ and _____________________________, of legal ages,

single/married, both Filipino Citizen and a residents of Barangay ________________ and
__________________________________________, Negros Occidental, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and say:

That we personally know the person of ________________________________________________

born on ____________________________, to Spouses ____________________________ and
________________________________, at _____________________________________, since we used to live at
the same place and constant visitors of each other but not related to each other by
consanguinity

That the name of _________________________________________________________was erroneously

recorded in his/her ______________________________________________________________ as
________________________________________________________________;

That the true and correct name of _________________________________________________ is

______________________________________ as appearing in his/her ______________________________
attached herewith as Annex A and not ________________________________________________.

That _______________________________________ and _______________________________________,

refers to one and the same person, and that we are cognizant of such fact because we have
personally known her and their family for a long time and that the discrepancy aforementioned
was only due to pure inadvertence and was not intended to defraud any person or entity;

That we are executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purposes and intents this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of _________________
at Kabankalan City, Negros Occidental, Philippines.

___________________________
Affiant
ID No. ____________________
CTC No. __________________
Issued on _________________
Issued at __________________
____________________________
Affiant
ID No. _____________________
CTC No. ___________________
Issued on __________________
Issued at __________________

SUBSCRIBED AND SWORN to before me this ____ day of ______________ at Kabankalan

City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

JOINT AFFIDAVIT OF TWO (2) DISINTERESTED PERSONS

We, _________________________________________ and _________________________________________,

of legal ages, single/married, both Filipino Citizen and a resident of
________________________________ and _________________________________, Negros Occidental,
Philippines, after having been duly sworn to in accordance with law, do hereby depose and say:

That we personally know the person of _________________________________________________

born on _______________________, to Spouses _______________________________ and
___________________________________, at _____________________________________, since we used to live at
the same place and constant visitors of each other but not related to each other by
consanguinity

That the name of _____________________________________________________ was erroneously

recorded in his/her _______________________________________________ as
_______________________________________________________;

That the true and correct name of ____________________________________________ is

_____________________________________ as appearing in his/her ______________________________
attached herewith as Annex A and not _____________________________________.

That _________________________________________ and _____________________________________

refers to one and the same person, and that we are cognizant of such fact because we have
personally known her and their family for a long time and that the discrepancy aforementioned
was only due to pure inadvertence and was not intended to defraud any person or entity;

That we are executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purposes and intents this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of _______________
2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________
Affiant
ID No. _________________
CTC No. ________________
Issued at. _______________
Issued on. _______________
_________________________
Affiant
ID No. __________________
CTC No. _________________
Issued at. ________________
Issued on. ________________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

JOINT AFFIDAVIT OF TWO (2) DISINTERESTED PERSONS

We, _________________________________________ and _________________________________________,

of legal ages, single/married/widow/widower, both Filipino Citizen and a resident of
________________________________ and _________________________________, Negros Occidental,
Philippines, after having been duly sworn to in accordance with law, do hereby depose and say:

That we personally know the person of _________________________________________________

born on _______________________, to Spouses _______________________________ and
___________________________________, at _____________________________________, since we used to live at
the same place and constant visitors of each other but not related to each other by
consanguinity

That the date of birth of _______________________________________________ was erroneously

recorded in his/her _______________________________________________ as
_______________________________________________________;

That we declare, confirm and affirm that ______________________________________ has been

using the date of birth ___________________________ in all his/her documents and transactions;

That we are not cognizant of such facts because we have known

_______________________________________ (complete name) for a long period of time being long
neighbors and close family friend;

That the discrepancy as to the date of birth of _________________________________ was only

due to pure inadvertence and was not intended to defraud any person or entity;

That we are executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purposes and intents this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of _______________
2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________
Affiant
ID No. _________________
CTC No. ________________
Issued at. _______________
Issued on. _______________
_________________________
Affiant
ID No. __________________
CTC No. _________________
Issued at. ________________
Issued on. ________________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

JOINT AFFIDAVIT OF TWO (2) DISINTERESTED PERSONS

We, _________________________________________ and _________________________________________,

of legal ages, single/married/widow/widower, both Filipino Citizen and a resident of
________________________________ and _________________________________, Negros Occidental,
Philippines, after having been duly sworn to in accordance with law, do hereby depose and say:

1. That we personally know the person of _______________________________ and

_______________________________, being an acquaintance for a long period of time;

2. We declare, confirm and affirm that _________________________________ and

________________________________ were married on __________________________________ at
________________________________, solemnized by _________________________________________;

3. The fact of their MARRIAGE was not immediately registered to the Local Civil Registrar
of ______________________________________________________________;

4. The failure to report the Fact of MARRIAGE of ____________________________________ and

_______________________________________ was only due to pure inadvertence and was not
intended to defraud any person or entity;

5. We are not related by affinity or consanguinity to the above mentioned person;

6. That we are executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purposes and intents this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of _______________
2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________
Affiant
ID No. _________________
CTC No. ________________
Issued at. _______________
Issued on. _______________
_________________________
Affiant
ID No. __________________
CTC No. _________________
Issued at. ________________
Issued on. ________________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, _________________________________________ , of legal age, single/married/widow/widower,

Filipino Citizen and a resident of ________________________________________, Negros Occidental,
Philippines, after having been duly sworn to in accordance with law, do hereby depose and say:

That I was born on _____________________________ at _____________________________________,

Negros Occidental to spouses ___________________________ and ____________________________ the fact
of my birth was duly registered at the Local Civil Registrar of ________________________________
Negros Occidental, copy of my Birth Certificate with Registry No. _________________________ is
hereto attached as Annex A;

That when I got a copy of my Certificate of Live Birth from the National Statistics Office, I
discovered that my sex/gender is _____________________ in Entry No. 2 therein was not marked;

That my true and correct sex/gender is ____________________, copy of my Medical

Certificate indicating my sex/gender is hereto attached as Annex B;

That the omission was only due to pure inadvertence and was not intended to defraud
any person or entity;

That I am executing this Affidavit of Supplemental Report to attest to the truthfulness of

the foregoing facts and in order to request the Local Civil Registrar of Kabankalan City, Negros
Occidental to supply the omitted reference as to my true and correct sex/gender, which is
_____________________ to entered in my Certificate of Live Birth with Registry No. ________________.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of _______________
2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________
Affiant
ID No. ___________________
CTC No. _________________
Issued at. ________________
Issued on. ________________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

AFFIDAVIT OF LOSS
(School ID)

I, __________________________________________, _______ years old, single/married,

Filipino Citizen and a resident of __________________________________________________, Negros
Occidental, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and say:

That I am a ______ year student taking ______________________________________ at

___________________________________________________, Negros Occidental;
That the authorities of the above-mentioned school issued a
__________________________________________ in my favor;

That the same lost and that I exerted diligent efforts to locate the same, but to no
avail. Hence, it is now considered beyond recovery;

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

statements and to from the said school for the issuance of a new
__________________________________________ in my favor in lieu of that which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________,

2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________________________
(Signature over printed name)
Affiant
ID NO. __________________________
CTC No. ________________________
Issued at. _______________________
Issued on. ______________________

SUBSCRIBED AND SWORN to before me this _________________________, 2017 at

Kabankalan City, Negros Occidental, Philippines.
REPUBLIC OF THE PHILIPPINES)
CITY OF KABANKALAN ) S.S.
x - - - - - - - - - - - - - - - - - - ---- - - - -x

AFFIDAVIT OF LOSS

I, __________________________________________, of legal age, single/married, Filipino

Citizen and a resident of __________________________________________________, Negros
Occidental, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and say:

That I am a keeper of a/an _____________________________________________ duly issued

by the __________________________________ in the name of
______________________________________ with No. ______________________.

That the said _____________________________________ was lost in my possession and

its whereabouts could not be ascertained despite diligent efforts having been exerted.

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

statements and to request the agency/office concerned to issue a new _______________ in
favor of _____________________________________.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________,

2017 at Kabankalan City, Negros Occidental, Philippines.

_________________________________________
(Signature over printed name)
Affiant
ID NO. __________________________
CTC No. ________________________
Issued at. _______________________
Issued on. ______________________

SUBSCRIBED AND SWORN to before me this _________________________, 2017 at

Kabankalan City, Negros Occidental, Philippines.