Republic of the Philippines)
________________________)          s.s.
                               AFFIDAVIT OF LOSS
      I, JUAN D. CRUZ, of legal age, married, Filipino and a resident of
_______________________________________, after having been duly sworn to in
accordance with law, hereby depose and state:
       That I am the mother and guardian of JUAN E. CRUZ, JR, 15 years of age,
finishes first year high school at National High School, (address);
      That when my son came to reason to transfer at LOKAL High School in
(ADDRESS), from National High School, and one of the requirements thereof is
to submit the Form 137 from the last attended school;
       That the said Form 137 issued by the National High School, found missing
despite diligent efforts to look for and locate the same proved futile; hence, it is
presumed as lost and deemed beyond recovery;
       That said FORM 137 did not transfer to any third person to make illegal
use of it, but was lost only due to the foregoing reason;
      That I am executing this affidavit in order to attest to the truth of the
above and for all legal intents and purposes.
      IN WITNESS WHEREOF, I have hereunto set my hand this _______ DAY
OF ____________ at ___________________________.
                                                 JUAN D. CRUZ
                                                 Affiant
       SUBSCRIBED AND SWORN to before me this _____ day of __________
at ________________________.
                                                 Notary Public