Affidavit - CHAINSAW

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Republic of the Philippines )

Dumaguete City . . . . . . . . ) S.S.

AFFIDAVIT OF LOSS

I, CLARO MACIAS, of legal age, Filipino, married with residence and postal
address at Casile, Dauin, Negros Oriental, Philippines, state under oath as follows:

That I am the permit holder of a Permit to Cut Coconut Trees issued by the
Philippine Coconut Authority (PCA), Dumaguete City, on 05 April 2019 with PTC No.
R7-PTC-10169 under application number 2019-0079-N. A photocopy of which is hereto
attached as reference;

That I was in possession of the original copy of the Permit to Cut Coconut Trees;

That on 20 May 2019 at around 8:00 o’clock in the morning, when I was
searching for the original copy of the Permit to Cut Coconut Trees for purposes of
transporting the cut coconut trees, I discovered that it was no longer inside the envelope
where I kept all my pertinent documents;

That diligent efforts to recover the same was futile and I now considered the said
original copy of the Permit to Cut Coconut Trees to be lost beyond recovery;

That the original copy of the Permit to Cut Coconut Trees was not mortgaged to
any lending or banking institution and that it was not liable to any third party claim;

That I am executing this affidavit to attest the veracity of my foregoing statements


and to support my claim with the Philippine Coconut Authority (PCA), Dumaguete City in
lieu of the lost original copy of the Permit to Cut Coconut Trees, and for the transport of
the cut coconut trees, and for whatever purpose this may serve best.

IN WITNESS WHEREOF, I hereunto set my hand this _____________ in


Dumaguete City, Philippines.

CLARO MACIAS
Principal
ID NO. _____________________

SUBSCRIBED AND SWORN to before me a Notary Public of the City of


Dumaguete and the Municipalities of Sibulan, Valencia, Bacong, Dauin and Siaton, this
____________ in the City of Dumaguete.
Doc. No. __;
Page No. __;
Book No. __;
Series of 2019.

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