Republic of the Philippines)

Iligan City, Lanao del Norte) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, Maguidala Lampa Razol, of legal age, Filipino, single/married, and a resident of

Brgy. Denaig, Poona-Piagapo, Lanao del Norte , after having been sworn in accordance
with law, hereby deposes and states the following:

1. I am holder/owner/ or possessor of the following identification card / document:

4Ps Identification Card and 4Ps Cash Card.

2. I have recently discovered the said item/s is/are irretrievably lost and can no
longer be found despite diligent efforts to locate the same;

3. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

Maguidala L. Razol
Affiant

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below.
Signed this 28th of June ,2017 at Iligan, City Philippines.
 WITNESS MY HAND AND SEAL.

Notary Public

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