Republic of the Philippines )

_______________________________ ) S.S

AFFIDAVIT OF LOSS

I, BASILIA GAN, of legal age, Filipino, widow and a resident of

Poblacion, Taytay, Palawan, after having been duly sworn in
accordance with law, hereby depose and say:

1. That I am a holder of a BIR TIN card, PhilHealth identification card

Postal identification card;

2. That I used to put said identification cards inside my wallet;

3. That sometime on May 13, 2017, at around ten (10) oclock in

the morning at New Public Market at Poblacion, Taytay, Palawan, I
discovered that the above-mentioned identification cards was no
longer in my wallet where I used to place it;

4. That despite diligent search and efforts to locate the said

identification cards, I could not find the same such that I believe
that it is now lost beyond recovery;

5. That said identification cards was not confiscated by the

authorities or used in violation of the law;

6. That I am executing this affidavit to attest to the truth of the

foregoing facts and to request for a replacement of the above-
mentioned identification cards from the respective agency and
for whatever legal purposes it may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature

__________________ in _________________________.

BASILIA GAN/Affiant
Id No: ____________/_____________

SUBCRIBED AND SWORN TO before me this _________________ in

________________________, affiant exhibiting to me her valid proof of
identification as indicated below her name.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.