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REPUBLIC OF THE PHILIPPINES)

___________________________) S.S.

AFFIDAVIT OF LOSS

I, Rolando C. Contillo, of legal age, Filipino, and with business address at Unit 301, Lancaster
Hotel, 622 Shaw Blvd., Brgy. Highway Hills, Mandaluyong City, after having been duly sworn to in
accordance with law, do hereby depose and state that:

1. I am an employee of Whiteport, Inc., a corporation duly established and existing under the
Philippine laws with principal address at Unit 301, Lancaster Hotel, 622 Shaw Blvd., Brgy.
Highway Hills, Mandaluyong City, as a General Service Clerk;

2. As such, I am responsible for transacting with different government offices/ agencies in


securing various permits and licenses as may be needed for the Corporation. Hence, I was
required by my employer to apply for several Identifiation Cards such as but not limited to
UMID, PhilHealth, TIN, PAG-IBIG, and Driver’s License and was provided an Employee ID
as these was usually being required to be presented in making business transactions and is
equally important for my personal dealings with the said offices;

3. In my everyday way to and from the office, I used to drive with my personal service
motorcycle with my wallet tucked in the back pocket of my pants;

4. However, sometime in the later week of July 2017, I was surprised to have known that my
wallet containing all my important identification cards, was already missing as it might have
been accidentally fell-off from the back pockets of my pants then while I was driving my
motorcycle on my way to office that day;

5. I have exerted diligent efforts to retrieve said wallet along with my IDs, but all turned out
futile;

6. Said Identification Cards have not been confiscated by any officers of law by reason of
violation of laws, rules, orders or regulations nor were it used as collateral to any loan;

7. I am applying for a new Identification Cards (i.e. UMID, PhilHealth, TIN, PAG-IBIG, Driver’s
License and Employee ID, etc.) in furtherance with my personal and business transactions
which may require the presentation of said missing IDs;

8. As such, I am executing this Affidavit to attest to the truthfulness of the foregoing and in
connection to my application for the re-issuance of the above-mentioned IDs with the
concerned government offices in liue of the lost ones and for whatever legal intents this may
serve.

IN WITNESS HEREOF, I have hereunto set my hand this ____________________________ at


___________________________, Philippines.

ROLANDO C. CONTILLO
Affiant
SUBSCRIBED AND SWORN to before me this _______________________, at
____________________, Philippines, affiant exhibiting to me his _______________________________ as
competent evidence of his identity.
NOTARY PUBLIC
Doc. No. _____
Page No. _____
Book No. _____
Series of 2017.