REPUBLIC OF THE PHILIPPINESPROVINCE OF SORSOGONCITY OF
SORSOGON
AFFIDAVIT OF LOSS
I, DELIA E. SUPILANA, of legal age, Filipino, widow, and a
resident of Brgy. Calaw, Prieto Diaz, Sorsogon, after having been
duly sworn in accordance with law, hereby depose and say:
1. That I am a DEPED Teacher and a registered member of the
Mutual Aid System of the Manila Teachers Mutual Aid System, Inc, 91
Gen. Luna St., Malabon, Metro Manila;
1. That a Mutual Retirement Benefit System (MRBS) Policy
contract was issued to me;1. That unfortunately said MRBS Policy
contract was misplaced when the Province of Sorsogon was devastated
by a typhoon last July, 2014 and could no longer be located at our
residence;1. That due efforts has been made in order to retrieve
said MRBS Policy contract, but to no avail, thus, I am considering
it lost forever;1. That I am executing this affidavit to attest to
the foregoing facts and for purposes of my claim application for
benefit under the Mutual Retirement Benefit System.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
8th day of June 2015 at Sorsogon City.
DELIA E. SUPILANA
SUBSCRIBED AND SWORN to before me this 8th day of June 2015,
affiant exhibited his Deped Employee ID No. 5020660.
