You are on page 1of 2

R epublic of the P hilippines C it y of M anila

) )

S.S.

A F F I D AV I T
I, C arlo An gelo W. Orb e, addres s at Block 6 Lot F ilipino, w ith res idence and pos tal after bein%

! " outhern City, I#us , Ca$ite,

s w orn to law hereb y depos e and s tate that&

) ' n !( ) anuary *! ( I w as on #y w ay ho#e fro# a #e etin% when I noticed that #y w allet w as #is s in% fro# #y back pocket+ *) I s earched for #y w allet w ithin the i##e di ate $icinit y but to no a$ail+ ,) - #on% thos e los t w as #y P RC Licens e Identifica tion Card w ith Licens e no. / !6(010 +

() I a# e2ecutin% this affida$it of los s to put on record the los s of #y P RC Licens e Identifica tion Card and to facili tate the replace#ent of the s a#e FU R THER , A FFI AN T S AY ETH NA U GHT. I N WI TN ESS WHER EOF , I ha$e hereunto s et #y hand at P as a y C it y, P hilippines , the *, t h day of ) anuary *! (.

C arlo An gelo Orb e Affiant R epublic of the P hilippines C it y of M anila ) )

S.S.

" 3 B" CRIB45 - 65 " 7' R6 8' before #e this 999999 da y of 9999999999999999 *! (, Affiant e2hibitin% to #e his Co##un it y 8a2 C ertific ate 6 u#ber 999999999999999, is s ued at 999999999999, is s ued on 999999999999, *!99. Notar y Public 5 oc. 6 o. 999999+ P a%e 6o. 999999+ B ook 6 o. 999999+ " eries of *! (.