Republic of the Philippines)

City of Marawi ) S.S

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AFFIDAVIT OF DAMAGE AND LOSS

[of Residential Building and Personal Belongings]

I, _____________________, of legal age, Filipino, married/single, a

permanent resident of Barangay ________________, Marawi City, Lanao del Sur,
Philippines after being duly sworn according to law, do hereby depose and
state:

1. That I am a resident of Barangay ______________, Marawi City, Lanao

del Sur, evidenced by the hereto attached Certification issued by the Office of
the Barangay Chairman marked as Annex “A”;

2. That I am the absolute and legitimate owner/sharer/renter of a parcel

of land upon which our home is built and located at ______________, Marawi
City as evidenced by herein attached document/s marked as Annex “_”;

3. That on May 23, 2017, the ISIS-inspired Maute Group wreaked havoc
in the city forcing me and my family to immediately flee to ___________________
for our safety, making me one of the Internally Displaced Persons from Marawi
City, evidenced by the hereto attached ______________marked as Annex “__” and
___________________ marked as Annex “__”;

4. Due to the terror caused by the Maute Group, we were able to pack
Only few clothings and left behind all other valuable personal properties:

ITEM DESCRIPTION ESTIMATED VALUE/

COST OF ACQUISITION

Or as enumerated in the herein attached List of Personal Properties Lost

with an estimated value P___________ marked as Annex “_”;

5. That massive airstrikes and bombings carried out by the Armed

Forces
of the Philippines throughout Marawi City caused the total burning/damage of
my house and all its contents, with an estimated value of P_______________;

6. That until now, we were not able to finally return to our home but was
only allowed to see and witness our properties, its damages and losses, during
the “kambisita” (visit) last ____________, copy of images of our houses/home is
herein attached and marked as Annex “_”;

7. That I am executing this Affidavit to attest to the truth of the foregoing

facts to support my claim for compensation and damages caused to my
personal and real properties and for other legal purposes that this may serve
her best.

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

September, 2018, Marawi City, Philippines.

SUBSCRIBED AND SWORN to before me this __ th day of September 2018,

Marawi affiant exhibited to me her valid proof of identification.