Republic of the Philippines )

Province of Cagayan ) S. S.
City of Tuguegarao )
x--------------------------------------x

AFFIDAVIT OF LOSS
I, RUVELYN AYUYANG, of legal age, Filipino and a resident of Babalag East,
Rizal, Kalinga, after having been duly sworn to in accordance with law, hereby
deposes and states:

1. That my husband, Rhoderick R. Ayuyang, had, in his lifetime, two (2)

firearms registered under his name:

2. Said firearms have the following description:

12 GA SHTGN Serial No. 10204415

45 PISTL Serial No. BA19012-08-246

3. That during the lifetime of my husband, I remember him telling me

that he lost his caliber 45 PISTL, as to how, I do not know;

4. As to his 12 GA SHTGN, said firearm was among those taken by the

robbers when he was robbed at Romualdez, Rizal, Kalinga on
January 6, 2011, which incident was reported to the Police Station
and was duly entered in the Police Blotter on same date;

5. That I do not know if my husband executed an Affidavit of Loss for

said firearms during his lifetime;

6. That when I received the letter from Rizal Municipal Police Station
pertaining to the said firearms, I sent them a letter dated March 27,
2018 informing them of the above-stated facts;

7. That I was advised to put my letter into an Affidavit of Loss form;

8. That for all intents and purposes, the above-described firearm

registered under the name of my late husband are considered lost
and can no longer be located despite diligent efforts;

9. I am executing this affidavit freely, voluntarily and intelligently to

attest to the truthfulness of the foregoing statements.

IN WITNESS WHEREOF, I have hereunto affixed my signature this __ day of

____________________ in Tuguegarao City, Cagayan, Philippines.

RUVELYN AYUYANG
Affiant
SIGNED IN THE PRESENCE OF:

IN WITNESS WHEREOF, I have hereunto affixed my signature this __ day of

__________________ in Tuguegarao City, Cagayan, Philippines.

Notary Public

Doc. No.
Page No.
Book No.
Series of 2018