Republic of the Philippines )

Camiling Tarlac
) S.S.

AFFIDAVIT OF LOSS
I, ANGELO ABUAN GRANDE, JR., 39 years old, Filipino citizen,
married, and a resident of Barangay Birbira, Camiling, Tarlac, after having
been duly sworn to in accordance with law, do hereby depose and state
THAT:
1. As a tricycle driver, on January 6, 2016 in the morning, I placed
my wallet in my pocket and drove my tricycle to transport some
passengers from our barangay going to our terminal located
beside the Camiling Public Market, Camiling, Tarlac;
2. Upon reaching our terminal, I took my wallet out from my pocket
to get money. While I was counting my money, I placed my
wallet on top of my tricycles ceiling for a awhile;
3. My wallet contained my Professional Drivers License ID Card,
Voter ID Card, original Official Receipt of my tricycle, some cash
and other personal belongings;
4. Thereafter, I transported other passengers from our terminal
going to Barangay Birbira, Camiling, Tarlac. Upon reaching our
destination, I noticed that my wallet was missing;
5. Immediately, I searched for my wallet inside the tricycle but I
found nothing. I asked my passengers if they have seen the
same but they answered in the negative. Also, I went back to our
tricycle terminal and asked my fellow drivers if they have seen
my wallet or the above-mentioned ID cards and papers but it
was in vain;
6. All efforts exerted to locate the said wallet, my Professional
Drivers License card, Voter ID card, and original Official Receipt
of my tricycle proved futile; hence, I now consider them as lost
and beyond recovery;
7. The said drivers license, official receipt and voter ID were
neither confiscated by any authority nor pledged nor used as a
security for any transaction or obligation;

8. Finally, I am executing this Affidavit to attest to the truth of the

foregoing statements and for all legal intents and purposes this
may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature
this 8 day of January, 2016 at Camiling, Tarlac.
th

ANGELO A. GRANDE, JR.

Affiant

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant exhibited before me his Police Clearance with
Control No. 20160108003 issued by the Camiling Police Station, Camiling,
Tarlac issued on January 8, 2016.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2016.