REPUBLIC OF THE PHILIPPINES)

City of Cebu) S.S.

x-----------------------x

AFFIDAVIT OF LOSS

I, JESYL MARIE B. HUGO, Filipino, of legal age, married, and a resident of Subangdaku, Mandaue
City, after being duly sworn in accordance with law, depose and state:

1 That I was issued a UMID ID on about March 2015;

2 That to my surprise, I discovered last March 2016 that the said Identification Card could not
be found;

3 As all efforts to find the same proved unrewarding, it is now safe to conclude that recovery
of the same is an impossibility;

4 Thus, I execute this affidavit to establish its loss and to support my application for the
issuance of a new UMID Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of October 2018 at Cebu
City, Philippines.

JESYL MARIE B. HUGO

affiant

SUBSCRIBED AND SWORN to before me, this 24th day of October 2018, by the Affiant who is
personally known to me who exhibited her NBI Clearance No. B645BJNE78-AT235736 issued at Cebu City.

ATTY. PAULO A. ESCOBER

NOTARIAL COMMISSION NO. 113-16
NOTARY PUBLIC FOR CEBU CITY UNTIL 12/31/19
ROLL NO. 65206
IBP NO. AR000186, CEBU CITY,12/20/17(FOR2018)
PTR NO. 1433824, CEBU CITY,12/28/17(FOR 2018)
MCLE COMPLIANCE EXEMPT
2nd Floor, Santiago Shipyard
Jose L. Briones Ave., North Reclamation Area
Cebu City 6000
Tel. No.: (032) 260 2829
Email Address: laocenizacane@gmail.com

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