REPUBLIC OF THE PHILIPPINES

QUEZON CITY, METRO MANILA

)
) S.S.

AFFIDAVIT OF LOSS
I, ERMELINDO A. COLUMNAS, Filipino, of legal age,
widower and a resident of No. 0073 Purok Lower Lumbia,
Pagadian City, after having been duly sworn to in accordance
with law, do hereby depose and state:
1. That I was issued by the Armed Forces of the Philippines
with a Retired Military Identification Card;
2. That the afore-stated Drivers License was contained in
my wallet;
3. That sometime on August 2013, when I am on my way
riding on a public utility jeepney traversing Edsa to
Aguinaldo my wallet inadvertently fell-off from my
pocket;
4. That unfortunately, however, despite diligent and
exhausted efforts exerted, the same could no longer be
recovered;
5. That for this reason, I am declaring and considering my
aforesaid Retired Military Identification Card as lost
beyond recovery; and
6. I have executed this Affidavit to attest to the truth and
veracity of all the foregoing for all legal intents and
legitimate purpose this may serve.
Affiant further sayeth naught
IN WITNESS WHEREOF, I have hereunto set my hand
and affixed my signature on this 26 th day of September, 2013, in
Quezon City.

ERMELINDO A. COLUMNAS
Affiant

SUBSCRIBED AND SWORN to before me on the date

and place above-written. Affiant exhibited to me his membership
ID with NO. 51962 issued by PNP.
Doc. No._____;
Page No._____;
Book No._____;
Series of 2013.