REPUBLIC OF THE PHILIPPINES)

OLONGAPO CITY ) S.S.

AFFIDAVIT OF LOSS

I, ARMANDO G. PAJE, of legal age, Filipino, married, and a resident of

Magsaysay, Castillejos, Zambales, after being sworn in accordance with law, depose
and say that:

1. I was issued the following Identification Cards (briefly, “IDs”), which I

usually keep inside my wallet:

[a] Driver’s License

[b] Social Security Services (SSS) ID; and
[c] Voter’s ID

2. However, I lost my wallet together with all its contents.

3. Despite diligent search, I was not able to find the same.

4. I am executing this Affidavit to attest to the truth of the foregoing, in

support of my application for the re-issuance of new IDs, and for all legal intents and
purposes it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of

_______________, 2018, Olongapo City, Philippines.

ARMANDO G. PAJE
Affiant

SUBSCRIBED and sworn to before me, in Olongapo City, this _____ day of
________________, 2018.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2018.