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AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES )


CITY OF CEBU ) S.S.

I, BRYLE V. VILLABAN, Filipino, of legal age, residing at Coca St. Brgy. Guba, Cebu City,
after having been sworn in accordance with law hereby depose and state the following:

1. I am the holder, owner and possessor of the following identification cards / documents:
a. Professional Regulation Commission Identification Card,
b. Voter’s Identification Card,
c. Philhealth Identification Card, and
d. Students' Permit.

2. On October 2017, while riding my motorcycle, I got off-balanced and did not notice that
my wallet, where all the said documents were kept, fell off.

3. The said items are irretrievably lost and can no longer be recovered despite my diligent
efforts.

4. These said identification card and student’s permit were not confiscated by any officer of
the law by reason of any violation of any law, ordinance, presidential decree or rules and
regulation of the said Commission; and neither was it offered as collateral for any loan.

5. I hereby execute this affidavit to attest to the truth of the foregoing and process the
replacement of the said identification cards/documents.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of November 2017 at
Mandaue City, Cebu, Philippines.

BRYLE V. VILLABAN
Affiant

SUBSCRIBED and SWORN TO before me this _______ day of ________________ at


_______________________________ by the affiant, Bryle V. Villaban, who exhibited his
_____________________________ as competent evidence of identity.

WITNESS MY HAND AND SEAL.

Doc. No. : ________;


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