Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF LOSS
I, PO2 ROMMEL C MENDOZA, of legal age, Filipino citizen, married,
and a resident of #257 Barangay Tagumbao, Gerona, Tarlac, after having
been duly sworn to in accordance with law, do hereby depose and state
THAT:

1. In the evening of June 3, 2017, upon reaching home, I discovered

that my wallet which I earlier placed at the back pocket of my
pants was missing;

2. My wallet contained some cash, my Philippine National Police ID

Card, Professional Drivers License Card, Professional Regulation
Commission ID Card (Electronics and Communication Engineer)
and other personal belongings;

3. Right away, I carefully checked the other pockets of my pants but I

did not found my wallet. I paused for awhile and tried to recall if I
placed it somewhere else or was transferred in my bag but it was
in vain;

4. All the diligent efforts exerted to locate the said wallet and its
contents proved futile, hence, I now consider it and its contents as
lost and beyond recovery;

5. The above-said IDs were never confiscated by any authority nor

pledged to secure any obligations;

6. I am executing this Affidavit to attest to the truth of the foregoing

statements and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 5th day

of June, 2017 at Camiling, Tarlac, Philippines.

ROMMEL C MENDOZA
Affiant

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant presented before me his Police Clearance with
Control No. 20170605017 issued by the Camiling Police Station, Camiling,
Tarlac on April 11, 2017.

Doc. No.:________;
Page No.:________;
Book No.:________;
Series of 2017.