REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA
) S.S.

AFFIDAVIT OF LOSS
I SHIRLEY TIDLOS RAMIRE, of legal age, Filipino, and a resident of 2166
Gerardo Mindanao St. Sampaloc Manila, after having been duly sworn to in accordance
with law do hereby depose and state:
That I am a holder of Voters Identification Card issued to me by the Commission
on Election (COMELEC);
That for causes, reasons and circumstances beyond my control, I lost the possession
of the said Voters Identification Card;
That I am executing this affidavit for the purpose of showing under oath the truth
of the foregoing facts and circumstances;
Further, I am also executing this affidavit for whatever legal purposes this may
serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of
November 2014 in the City of Manila.

SHIRLEY TIDLOS RAMIRE

Affiant

SUBSCRIBED AND SWORN TO before me this 17th day of November 2014 in

the City of Manila.

Doc. No. _________;

Page No.__________;
Book No._________;
Series of 2014.