Aol - Mr. Valenzuela.docx

REPUBLIC OF THE PHLIPPINES) S.S. CITY OF __________

AFFIDAVITOFLOSS I, VALENZUELA, ROJOHN MESIERA., Filipino, of legal age, and with postal address at Pleasantville, Brgy. Iyam Lucena City 4301, Quezon Province, after been duly sworn to in accordance with law, hereby depose and state that: 1. That I have loss my copy of Board Certificate with PRC License No. 0149536 due to submission to various institutions. 2. That I have forgotten whether I submitted my original copy or not. Furthermore, I am requesting the apprehension of concerned agency to bear with me as I want to retrieve the copy of my Board Certificate with PRC License No. 0149536. That I am executing this Affidavit to attest to the truth of the foregoing and whatever legal purpose it may serve. IN WITNESS WHEREOF, I have set my hand below this ____ day of _____ In __________________.

VALENZUELA, ROJOHN M. Affiant SUBSCRIBED AND SWORN to me before this ______day of __________.

NOTARY PUBLIC Doc. No. ____ Page NO. ____ Book No. ____