Republic of the Philippines )

SS
Quezon City, Metro Manila)
x-----------------------------------x

AFFIDAVIT OF LOSS

I, Mark Anthony T. Del Mando 29 years old single, Police Officer, a native of Pampanga and a resident of
No. 350 Osmeña St Brgy. Sto. Niño, Sapa Sto. Tomas Pampanga, after having been sworn in accordance
with law, hereby deposes and states the following;

1. That, I am a holder of my PFT document result last August 2017.

2. I have recently discovered the said document is irretrievably lost and can no longer be
found despite diligent efforts to locate the same;

3. That, I am executing this affidavit for claiming copy of my result of PFT and to attest the
truthfulness of the forgoing narration of facts and for whatever intents and purpose it may
legally serve.

IN WITNESS WHEREOF, I have hereunto set my hand this__th day December 2018 in
Quezon City, Metro Manila, Philippines.

Mark Anthony T. Del Mando

Affiant

SUBSCRIBED AND SWORN to before mew this__th day of December 2018 in Quezon
City, Metro Manila, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2018.