Ondoy

REPUBLIC OF THE PHILIPPINES)
CITY OF PASIG )S. S.
AFFIDAVIT OF LOSS
I, GIRLEY T. DELA CRUZ, of legal age, married, Filipino, and

resident of No. 1624 Lamberto St., Villa Alfonso, Bambang, Pasig City, ,
after having been sworn in accordance with law do hereby depose and
state:
1. That I am a holder of an apple i-phone 5c with globe sim card
bearing the no. 09178902151;
2. That on March 27, 2014 around 5:30 pm to 6:00pm , while I

am texting using another cell phone, I was bumped by a man which I
ignored due to busy texting and after a few minutes I noticed that my
apple i-phone, which is on my paper bag, was missing, presumably the
same was picked by the said man having that kind of modus operandi;
3. That diligent search and efforts were exerted to locate the

same but to no avail;
4. That for all intents and purposes, aforesaid apple i-phone is

now considered lost;
5. That I am executing this affidavit to attest to the veracity of

the foregoing facts, for all intents and for whatever legal purpose it may
serve;
IN WITPNESS WHEREOF, I have hereunto set my hand this

_______________ at Pasig City.
GIRLEY T. DELA CRUZ

Affiant
SUBSCRIBED AND SWORN to before me this ___________________ at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014.
AFFIDAVIT OF LOSS
I, ANTONIO D. ALTEZA, of legal age, Filipino, and with residence

and postal address at No. 16 J. Feliciano St., Brgy. Sagad, Pasig City, after
having been duly sworn to in accordance with law, hereby depose and say:
1. That I am a holder of a Philippine Passport duly issued by the

Department of Foreign Affairs, Metro Manila;
2. That during the typhoon “Ondoy” on September 26, 2009, our

house was flooded and inadvertently, the above mentioned
Philippine Passport which was then under my possession, was
included in the documents affected by the said disaster;
3. That diligent search and efforts were exerted to locate the same
but to no avail;
4. That for all intents and purposes, aforesaid Passport is now

considered lost;
5. That I am executing this affidavit to attest to the veracity of the

foregoing facts, for all intents and for whatever legal purpose it
may serve and for the issuance of new Passport;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of

Pasig City.
ANTONIO D. ALTEZA
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of

______________at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014.
AFFIDAVIT OF LOSS
I, JOSEPH MABALAY BITANGCOL, of legal age, Filipino, and with

residence and postal address at No. 169 Washington St., Greenpark
Village, Manggahan, Pasig City, after having been duly sworn to in
accordance with law, hereby depose and say:
1. I was previously employed at ABS-CBN and accordingly I was

issued documents among others my Income Tax Return for Year
2008;

Income Tax Return for Year 2008 which was then under my
possession, was included in the documents affected by the said
disaster;
but to no avail;
3. For all intents and purposes, aforesaid Income Tax Return for Year
2008 is now considered lost;
4. I am executing this affidavit to attest to the veracity of the

may serve.;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of,
Pasig City.
JOSEPH MABALAY BITANGCOL

Affiant
SUBSCRIBED AND SWORN to before me this ____ day of at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, MERDAN M. BALERITE, of legal age, Filipino, and with residence and

postal address at 254 Dr. Pilapil St., Brgy. San Miguel, Pasig City, after having been
duly sworn to in accordance with law, hereby depose and say:
1. That I am a holder of an ATM Card issued by BPI Family Savings Bank,

Kapasigan, Pasig City;
2. That sometime on September 14, 2013, the said ATM card was nowhere
to be found in my possession, presumably the same was misplaced;
3. That diligent search and efforts were exerted to locate the same but to no
avail;
4. That for all intents and purposes, aforesaid ATM Card is now considered
lost;
5. That I am executing this affidavit to attest to the veracity of the foregoing

facts, for all intents and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 19th day of

September 2013, Pasig City.
MERDAN M. BALERITE
Affiant
SUBSCRIBED AND SWORN to before me this 19th day of September 2013 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, ELVIRA V. VARGAS, of legal age, Filipino, and with office address

at Human Resource Department, 4th Floor, Pasig City Hall Buiding, Pasig
City, after having been duly sworn to in accordance with law, hereby
depose and say:
1. That I am presently employed at City Government of Pasig

detailed at Human Resource Department as Payroll Clerk and one
of my duties and responsibilities is the preparation of all the
payrolls of casual employees of the City Government of Pasig;
2. That sometime last week of October 2013 while I was on my sick

leave, the Payroll for the period of OCTOBER 1-15, 2013 of
Vice Mayor’s Office Personnel (11 employees) was nowhere
to be found in my office table, presumably the same was
misplaced under unknown circumstances;
but to no avail;
4. That for all intents and purposes, aforesaid Payroll for the period
of OCTOBER 1-15, 2013 of Vice Mayor’s Office Personnel
(11 employees) is now considered lost;

may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ____th day

of November 2013, Pasig City.
ELVIRA V. VARGAS
Affiant
SUBSCRIBED AND SWORN to before me this ____th day of November
2013 at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, HECTOR P. CAJAPIN, of legal age, married, Filipino, and with

residence and postal address at No. 398 San Andres St., Pineda, Pasig City,
after having been duly sworn to in accordance with law, hereby depose
and say:
1. That I am one of the surviving children of the late Spouses

Prudente and Antonia Cajapin as such I was entrusted with the
safe keeping of pertinent documents relative to their estate;
2. Sometime on year 1995 while I was sorting our documents, I

noticed that the Cancellation and Release of Mortgage pertaining
to our title particularly Transfer Certificate Title Number (116564-)
-13348;-
but to no avail;
4. For all intents and purposes, aforesaid Cancellation and Release

of Mortgage is now considered lost;

foregoing facts and to request Security Bank and Trust Company
for the re-issuance of Cancellation and Release of Mortgage of our
property under Transfer Certificate Title Number (116564-)
-13348 ;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day

of____2013, Pasig City.
HECTOR P. CAJAPIN
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, ROGER G. BONANZA, of legal age, married, Filipino, and with
residence and postal address at No. 25 Bliss Sta. Lucia, Pasig City, after
1. That I was previously employed at City Government of Pasig and
as such I processed my Terminal Leave with the attached
documents relative to my resignation and other documents to be
submitted to COMELEC (Expenditures for Barangay Elections) ;
2. Sometime on November 27, 20013, while I was driving my motor

vehicle, I noticed that the envelope containing the
abovementioned documents pertaining to my resignation and the
expenses I incurred during the last Barangay election was slipped
off under unknown circumstances;-
but to no avail;
4. For all intents and purposes, aforesaid envelope containing the

abovementioned documents pertaining to my resignation and the
expenses I incurred during the last Barangay election are now
considered lost;

foregoing facts and for whatever legal purpose it may serve;

of____2013, Pasig City.
ROGER G. BONANZA
Affiant
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, JOYCE T. FAMULARCANO, of legal age, single, Filipino, and with

residence and postal address at No. 251 K Orchids St. San Miguel, Pasig City, after
1. I am presently undergoing Pasig Livelihood Foundation Inc. at the Gender

and Development (GAD) and I was issued a Identification Card;
2. On April 20, 2013, I noticed that my I.D. was missing in my I.D. holder and
nowhere to be found, presumably it slipped off in the course of ordinary
use thereof;
avail;
4. For all intents and purposes, aforesaid SPES I.D. is now considered lost;
5. I am executing this affidavit to attest to the veracity of the foregoing facts,

for all intents and for whatever legal purpose it may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of, Pasig
City.
JOYCE T. FAMULARCANO
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, HAZEL A. RESAGA, of legal age, married, Filipino, and with

residence and postal address at No. 491 F. Legaspi Ext., Maybunga, Pasig
depose and say:
1. I am presently employed at Commander Security Services, Inc. as

Security Officer and I was issued an ATM Card by Security Bank,
Cubao, Quezon City;
2. On last Saturday, August 24, 2013, I noticed that my ATM Card

issued by Security Bank, Cubao, Quezon City was missing and
nowhere to be found, presumably it was slipped off in the course
of ordinary use thereof;
but to no avail;
4. For all intents and purposes, aforesaid ATM Card issued by

Security Bank, Cubao, Quezon City is now considered lost;

may serve;
Pasig City.
HAZEL A. RESAGA
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013
AFFIDAVIT OF LOSS
I, MARK LESTER G. RIMANDO, of legal age, married, Filipino, and

with residence and postal address at No. 32 Bautista Comp., Brgy. Sta.
Lucia, Pasig City, after having been duly sworn to in accordance with law,
hereby depose and say:
1. I am presently employed at Handyman DC and accordingly I was

issued an ATM Card by Robinson’s Bank;
2. On last January 31, 2014, when my wife was on her way to

grocery, unknown persons forcibly took her belongings including
my ATM and other important documents;
but to no avail;
4. For all intents and purposes, aforesaid ATM Card issued by by

Robinson’s Bank is now considered lost;

may serve;
Pasig City.
MARK LESTER G. RIMANDO

Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014.

AFFIDAVIT OF LOSS
I, RICKY S. CRUZ, of legal age, Filipino, and with residence and postal
address at No. 2071 C.B. Cruz Street, Malasaga Pinagbuhatan, Pasig City, after
1. I am a holder of the following ATM Cards, to wit:
a. BDO ATM Card Kabayan Savings w/ Account No.

002782355453 Makati Branch;
b. CHINA Bank ATM Card Overseas Kabayan Savings w/ Account
No. 2035109369, Makati Head Office;
c. BDO ATM Card Kabayan Savings w/ Account No.
005600654066, POEA Branch; and
d. BPINOY ATM Card w/ Account No. 0479703434, Makati Branch.
2. Yesterday, April 7, 2014, when I was in Pasig public market, I noticed that
my wallet containing the said ATM Cards was missing. Presumably, my
wallet was stolen by unidentified culprit;
avail;
4. For all intents and purposes, aforesaid ATM Cards are now considered
lost;

City.
RICKY S. CRUZ
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014.
AFFIDAVIT OF LOSS
I, ARNOLD R. ALVAREZ, of legal age, single, Filipino, and with residence and
postal address at No. 38-18 Alvarez Compound, Maybunga, Pasig City, after having
been duly sworn to in accordance with law, hereby depose and say:
6. I am a holder of the following credentials/identification cards, to wit:
Professional Driver’s License Card issued by the Land Transportation

Office, Pasig City;
Firearm License with Serial No. _____________________ with
description (.45 Caliber Remington) issued by Philippine National Police
(PNP);
7. Yesterday, August 11, 2013, at around 10:00 a.m., I noticed that my wallet
containing among others the abovedescribed documents/identifications
was missing. Presumably, my wallet has been slipped off my pocket in
the course of ordinary use thereof; I only noted its loss while I was inside
my residential house;
avail;
9. For all intents and purposes, aforenamed credentials/identifications are

City.
ARNOLD R. ALVAREZ
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013
AFFIDAVIT OF LOSS
I, VIVIAN LIM, of legal age, Filipino, and with residence and postal address at
No. 233 Dr. Pilapil St., San Miguel, Pasig City, after having been duly sworn to in
1. That I am a holder of Papa’s Pawnshop Ticket Number 353499 dated

11/8/2012 for pawned item (ring) in the amount of Php1,000;
2. That sometime on January 4, 2013, I found out that my wallet where I put
said Pawn Ticket is missing presumably the same may have been taken by
person or persons unknown under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid Pawn Ticket is now considered
lost;

facts, for all intents and for whatever legal purpose it may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this 7nd day of

January 2013, Pasig City.
VIVIAN LIM
Affiant
SUBSCRIBED AND SWORN to before me this ______th day of January 2013

at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.
Republic of the Philippines)
City of Pasig...................…..) s.s
AFFIDAVIT OF LOSS
I, CASTORA TUAZON, of legal age, single, Filipino Citizen, and with

residence and postal address at 2 nd St., Morales Compound, Sta. Lucia,
Pasig City, after having been sworn in accordance with law do hereby
depose and state that:
1. I am the registered owner of a parcel of land covered by

Transfer Certificate of Title (TCT) No. PT-132444 containing an
area of Sixty (60) Square Meters, more or less situated at Brgy.
Rosario, Pasig City, Metro Manila;

Transfer Certificate of Title No. PT-132444 which was then under
my possession, was included in the documents affected by the
said disaster;
3. That diligent search and efforts were exerted to retrieve the

same but no to avail;
4. That for all intents and purposes the aforesaid Transfer

Certificate of Title No. PT-132444 is now considered lost;
5. That the said owner’s copy of the title of the abovedescribed

property has not been mortgaged or entrusted as collateral to
any third party/entity,
6. That I am executing this Affidavit to attest to the truth and

veracity of the foregoing facts and for whatever legal purpose it
may serve and to request for the issuance of a new owner’s
duplicate copy of said above mentioned title.

____ at Pasig City.
CASTORA TUAZON
Affiant
SUBSCRIBED AND SWORN to before me this ___ day of ______ at
Pasig City. Affiant exhibited to me her Postal ID No. ______________ and
valid until ____________.
Doc. No.
Page No.
Book No.
Series of 2012
AFFIDAVIT OF LOSS
I, CLARITA T. CASTILLO, of legal age, Filipino, widow, and with

residence and postal address at 247 C. Dr. Pilapil St., San Miguel, Pasig
depose and say:
1. That I am a holder of an ATM Card issued by Philippine National

Bank-Kapasigan, Pasig City Branch for my SSS Pension;
2. That I noticed that the said ATM card was found missing,
presumably the same was misplaced under unknown
circumstances;
but to no avail;
4. That for all intents and purposes, aforesaid ATM card. is now
considered lost;

may serve.;
Pasig City.
CLARITA T. CASTILLO
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.
City of Pasig...................…..) s.s
AFFIDAVIT OF LOSS
I, ARNEL P. ALCANTARA, of legal age, married, Filipino Citizen, and
with residence and postal address at Bldg 7A Room 403, Karangalan
Village, Manggahan, Pasig City, after having been sworn in accordance
with law do hereby depose and state:
1. I am a holder of Policy Contract issued by St. Peter Life Plan

under Policy Contract No. N12704452A;
2. That sometime on November 26, 2013, the aforesaid St. Peter

Policy
Contract which was then under my possession, was missing in
my
envelope presumably it was slipped off;

4. That for all intents and purposes the aforesaid St. Peter Policy
Contract is now considered lost;

may serve.

____ at Pasig City.
aRNEL P. ALCANTARA
Affiant

Doc. No.
Page No.
Book No.
Series of 2013

City of Pasig...................…..) s.s
AFFIDAVIT OF LOSS
I, MARIBEL ALCANTARA, of legal age, married, Filipino Citizen, and

with residence and postal address at Bldg 7A Room 403, Karangalan
Village, Manggahan, Pasig City, after having been sworn in accordance
with law do hereby depose and state:
1. I am a holder of Policy Contract issued by St. Peter Life Plan

under Policy Contract No. _____________________;
3. That sometime on November 26, 2013, the aforesaid St. Peter

Policy
Contract which was then under my possession, was missing in
my
envelope presumably it was slipped off;

4. That for all intents and purposes the aforesaid St. Peter Policy
Contract is now considered lost;

may serve.

____ at Pasig City.
MARIBEL ALCANTARA
Affiant

Doc. No.
Page No.
Book No.
Series of 2013

AFFIDAVIT OF LOSS
I, VERONICA L. SABEROLA, of legal age, Filipino, and with residence and
postal address at No. 131 Blk. 3, Lot 3, Isla Homes IV, Pinagbuhatan, Pasig City,
after having been duly sworn to in accordance with law, hereby depose and say:
5. I am presently employed at Yearluck Food and Industrial Corp. and I was

issued a Metro Bank ATM Card (Savings Account);
6. On October 21, 2012, the said ATM card was found missing, presumably it
slipped off from my pocket in the course of ordinary use thereof;
avail;
8. For all intents and purposes, aforesaid Metro Bank ATM card. is now
considered lost;

for all intents and for whatever legal purpose it may serve.;
City.
VERONICA L. SABEROLA
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, JAYSON M. AYTONA, of legal age, single, Filipino, and with residence and
postal address at No. 296 Estrada St., Zandroville, Nagpayong, Pinagbuhatan, Pasig
City, after having been duly sworn to in accordance with law, hereby depose and say:
11. I am presently undergoing SPES Program at the City Government of Pasig

assigned at Legal Office and I was issued a SPES Identification Card;
12. On April 15, 2013, I noticed that my SPES I.D. was missing in my I.D.
holder and nowhere to be found, presumably it slipped off in the course of
ordinary use thereof;
avail;
14. For all intents and purposes, aforesaid SPES I.D. is now considered lost;
City.
JAYSON M. AYTONA
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013
AFFIDAVIT OF LOSS
WE, GEORGE LUCZON and ALFREDO VICTOLERO, both of legal

age, Filipinos, and with office address at Bright Future Condo. Corp., Unit
147 B. F. Realty & Development Corp. Bldg, Pinagbuhatan, Pasig City, after
1. That we are the elected officers of BRIGHTFUTURE CONDO. COP.

With office address at the abovementioned address and
accordingly issued a Savings Passbook by MVSM (Bank of San
Mateo) Pasig City Market Branch;
2. On February 15, 2013, we noticed that the aforesaid Savings

Passbook issued by MVSM (Bank of San Mateo) Pasig City Market
Branch was found missing in our office, presumably it was slipped
off in the course of ordinary use thereof ;
but to no avail;
4. For all intents and purposes, aforesaid Savings Passbook issued

by MVSM (Bank of San Mateo) Pasig City Market Branch is now
considered lost;
5. That we are executing this affidavit to attest to the veracity of the

may serve and for the issuance of new Passbook/Bankbook.;
IN WITNESS WHEREOF, we have hereunto set our hands this ____ day
of, Pasig City.
GEORGE LUCZON ALFREDO VICTOLERO

Affiant Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.
AFFIDAVIT OF LOSS
WE, NORA B. COMIA and DIMAS DE GRACIA, both of legal age,

Filipinos, and with office address at Villa Cuana Phase 3, Pinagbuhatan,
Pasig City, after having been duly sworn to in accordance with law, hereby
depose and say:
1. That we are “Joint Depositors” of MVSM (Bank of San Mateo) Pasig

City Market Branch, and accordingly a holder of Savings
Passbook with Account No. 57-19620-8;
2. On January 09, 2014, we noticed that the aforesaid Savings
Passbook issued by MVSM (Bank of San Mateo) Pasig City Market
Branch was found missing while we were in Quiapo Church in
Manila, presumably was taken by unknown persons under
circumstances;
but to no avail;
4. For all intents and purposes, aforesaid Savings Passbook issued

by MVSM (Bank of San Mateo) Pasig City Market Branch is now
considered lost;

may serve and for the issuance of new Passbook/Bankbook.;
of, Pasig City.
NORA B. COMIA DIMAS DE GRACIA

Affiant Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014.

AFFIDAVIT OF LOSS
I, LUCILA L. DAMASCO, of legal age, Filipino, widow and with

residence and postal address at No. 35 B. Eicennower Bend St., Parkwoods
Green Executive Village, Maybunga, Pasig City, after having been duly
sworn to in accordance with law, hereby depose and say:
1. That I am an accredited of NFA Rice Retailer in Pasig City Mega

Market and accordingly a holder of NFA Retailer’s Passbook;
2. That last week, June 04, 2013, I noticed that my aforesaid NFA
Retailer’s Passbook issued by NFA was found missing in my stall,
presumably it was misplaced under unknown circumstances in
the course of ordinary use thereof ;
but to no avail;
4. For all intents and purposes, aforesaid NFA Retailer’s Passbook

issued by NFA is now considered lost;

may serve and for the issuance of new NFA Retailer’s Passbook;
of, Pasig City.
LUCILA L. DAMASCO
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.
AFFIDAVIT OF LOSS
I, DIOSA T. ANTIPONA, of legal age, Filipino, and with residence and postal
address at No. 373 San Agustin, Palatiw, Pasig City, after having been duly sworn to
in accordance with law, hereby depose and say:
1. That I am a wife of the late Dominador M. Antipona, Jr. a holder of an ATM

Card issued by Landband with account number 3087124001;
2. That on June 30, 2012, the said ATM card was found missing, presumably
the same was misplaced;
avail;
4. That for all intents and purposes, aforesaid ATM card. is now considered
lost;

facts, for all intents and for whatever legal purpose it may serve.;
City.
DIOSA T. ANTIPONA
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.
AFFIDAVIT OF LOSS
I, WARLITO M. PASCUA, of legal age, Filipino, and with residence and postal
address at 497 Acacia St., Napico, Manggahan, Pasig City, after having been duly
1. That I am a bonafide member of Pag-Ibig and accordingly a holder of

Certificate Loan Eligibility;
2. That sometime in 2006, the said Certificate Loan Eligibility was nowhere to
be found in Justice Ramon Jabson Urban Poor Association Inc., Cainta,
Rizal, presumably the same was misplaced;
avail;
4. That for all intents and purposes, aforesaid Certificate Loan Eligibility is now
considered lost;

facts, for all intents and for whatever legal purpose it may serve and for the
issuance of new Certificate Loan Eligibility;

October 2009, Pasig City.
WARLITO M. PASCUA
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of October 2009 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.

AFFIDAVIT OF LOSS
I, JESUCITO D. LEGASPI, of legal age, Filipino, and with residence and

postal address in Mandaluyong City, after having been duly sworn to in accordance
with law, hereby depose and say:
1. That I am employed at J.D. LEGASPI CONSTRUCTION;
2. That the said company has entered into a contract with the City
Government of Pasig for the supply, installation of aircondition units and
ventilation of Pasig City Children’s Hospital, Industria St., Kapasigan, Pasig
City;
3. That we applied for the Performance Bond under G (13) No. 0000548 for
the said project from Summit Guaranty & 1 Company, Inc.;
3. That however, the original copy of the said Performance Bond is missing,
presumably the same may had been misplaced under unknown
circumstances;
diligent search and efforts were exerted to locate the same but to no avail;
4. That for all intents and purposes, aforesaid Performance Bond under G (13)
No. 0000548 is now considered lost;
5.That I am executing this affidavit to attest to the veracity of the foregoing
issuance of new Certificate Loan Eligibility;

JESUCITO D. LEGASPI
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.
AFFIDAVIT OF LOSS
I, CHARMIEDEARN B. NAYNES, of legal age, Filipino, with residence and

postal address at 5 Erlyn Street, Bartville Subd., Dela Paz, Pasig City, after having
been duly sworn in accordance with law do hereby depose and say that:
1. That I am the owner of CBN INTERTRADE CORP. doing business at

Room 205 San Buena Building, Shaw Boulevard, Pasig City;
2. That the said business is duly registered at the Bureau of Internal Revenue
and issued a Certificate of Registration;
3. However, the original Certificate of Registration was missing, presumably

the same may had been misplaced under unknown circumstances;
avail;
5. That for all intents and purposes, aforesaid Certificate of Registration is now
considered lost;


__________________ 2013, Pasig City.
CHARMIEDEARN B. NAYNES
Affiant
SUBSCRIBED AND SWORN to before me this ___ of 2013 at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.
2. That the said organization is duly registered at the Bureau of Internal
Revenue and issued a Certificate of Registration with No. 007-119275-000;
3.That however, the copy of said Certificate of Registration is missing,

presumably the same was misplaced under unknown circumstances;
avail;
5. That for all intents and purposes, aforesaid Certificate of Registration is now
considered lost;


__________________ 2012, Pasig City.
MARITA A. CALAJE
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of ______________

2012 at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.
AFFIDAVIT OF LOSS
I, RAFAEL V. ISIDRO, of legal age, married, Filipino, and with residence and
postal address at no. 204 Stockholmes St. Green Park Village, Dela Paz , Pasig City,
1. That I am the registered owner of parcel of land , as a conjugal property

with OFELIA G. ISIDRO, situated at Barrio Santolan, Pasig City covered
and embraced under TCT no. PT-86759 containing an area of 222 Sqm
more or less;
2. That sometime in year 1995, the title of the said property was included in
the destruction caused by fire we suffered;
avail;
4. That for all intents and purposes, aforesaid title bearing the no. TCT no.
PT-86759. is now considered lost;
5 That I am executing this affidavit to attest to the veracity of the foregoing

City.
RAFAEL V. ISIDRO
Affiant
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.
AFFIDAVIT OF LOSS
I, CORAZON D. MENDIOLA , of legal age, Filipino, and with residence and

postal address at Sitio Tanglaw, San Isidro, Antipolo City, after having been duly
1. That I am a bonafide member of Social Security System and accordingly a

holder of digitized SSS I.D. with No. 33-6296876-4;
2. That sometime in February 25, 2008, the said SSS digitized I.D. was
nowhere to be found in our residence, presumably the same was
misplaced;
avail;
4. That for all intents and purposes, aforesaid SSS digitized I.D. is now
considered lost;

issuance of new SSS digitized I.D.;
CORAZON D. MENDIOLA
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, SHIRLEY B. CAYACO, of legal age, Filipino, and with residence and postal
address at Lot 4, Block 5, Munich St., Mercedes Village, San Miguel, Pasig City City,

holder of SSS I.D. with No. 33-9207195-1;
2. That on December 17, 2012, the said SSS I.D. was nowhere to be found in
our residence, presumably the same was misplaced;
avail;
4. That for all intents and purposes, aforesaid SSS I.D. is now considered lost;


of__________, Pasig City.
SHIRLEY B. CAYACO
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;

AFFIDAVIT OF LOSS
I, JESUS VIRGILIO B. DUENAS, of legal age, Filipino, and with residence

and postal address at No. 900 Mansanas St., Napico, Manggahan, Pasig City, after

holder of digitized SSS I.D. with No. 33-96068669;
2. That on March 17, 2013, I found out that my wallet inside my pocket
containing the said SSS digitized I.D. was missing and nowhere to be
found, presumably it slipped off in my pocket in the course of ordinary use
thereof;
avail;
considered lost;

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of March
2013, Pasig City.
JESUS VIRGILIO B. DUENAS

Affiant
SUBSCRIBED AND SWORN to before me this ____ day of March 2013 at

Pasig City.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2013.
AFFIDAVIT OF LOSS
I, JOVIE TOLEDO DAVID, of legal age, Filipino, single, and with

residence and postal address at No. 23 Red St., Greenfield Sto. Tomas,
depose and say:
1. I graduated at Pamantasan ng Lungsod ng Pasig last April 2013

and I am requesting for a copy of my Transcript of Records and I
was issued a Clearance of PLP;
2. However, sometime last May 2013, the said school Clearance was
missing and nowhere to be found presumably the same was
but
to no avail;
4. That for all intents and purposes, aforesaid school Clearance

issued by Pamantasan ng Lungsod ng Pasig is now considered
lost;

may serve and for the issuance of my Transcript of Records;
IN WITNESS WHEREOF, I have hereunto set my hand this

______________ at Pasig City.
JOVIE TOLEDO DAVID

Affiant
SUBSCRIBED AND SWORN to before me this ____________________ at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014

AFFIDAVIT OF LOSS
I, CAMELLA JION O. PALMES, of legal age, Filipino, single, and with

residence and postal address at MRH Bldg. 7A 406 Kaginhawaan St.,
Karangalan Village Manggahan, Pasig City, after having been duly sworn to
1. I graduated at Manggahan High School, Pasig City last April

2013 and I was issued a Report Card;
2. However, sometime last August 2013, the said Report Card was
missing and nowhere to be found presumably the same was
misplaced;
but
to no avail;
4. That for all intents and purposes, aforesaid Report Card issued by
Manggahan High School of Pasig City is now considered lost;

may serve and for the issuance of new Report Card;

______________ at Pasig City.
CAMELLA JION O. PALMES

Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014

AFFIDAVIT OF LOSS
I, LUCIANA C. CIDRO, of legal age, Filipino, and with residence and postal
address at Blk. 2 Lot 1 Bagong Silang St, Nagpayong, Pinagbuhatan, Pasig City,
1. I am the mother of JOHN CHRISTOPHER C. CIDRO, a 1 st year high
school at Pasig City Science High School, Pasig City and he was issued a
Admit Pass and School Identification Card Receipt;
2. I was informed by my son that on June 7, 2013, the said Admit Pass and
School Identification Card Receipt were missing and nowhere to be found
presumably the same was misplaced;
avail;
4. That for all intents and purposes, aforesaid Admit Pass and School
Identification Card Receipt are now considered lost;

issuance of new School I.D.;
IN WITNESS WHEREOF, I have hereunto set my hand this ______________

at Pasig City.
LUCIANA C. CIDRO
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, PATRICK M. DE NUESTO, of legal age, Filipino, and with

residence address at 651 Ignacio Street, East Bank Road Floodway, Sta.
lucia, Pasig City, after having been duly sworn to in accordance with law,
1. That I am a holder of Smart Sim Card with Phone No.

09206481808;
2. That sometime on October 2012, I noticed that said Sim Card was
nowhere to be found at my office presumably the same was
but to no avail;
4. That for all intents and purposes, aforesaid Smart Sim Card is now
considered lost;

may serve.

June 2013, Pasig City.
PATRICK M. DE NUESTO
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of June 2013 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.
AFFIDAVIT OF LOSS
I, ARMANDO NUŃEZ TABINAS, of legal age, Filipino, married, and

with residence and postal address at Blk 2 Lot 6, KROVA Kalawaan, Pasig
depose and say:
1. That I am a holder of a Philippine Passport duly issued by the

Department of Foreign Affairs, Metro Manila on Year 2008 ;
2. That on September 26, 2009, due to typhoon “Ondoy” our

community and our house were became flooded and the said
Philippine Passport was affected by the said calamity;
but to no avail;
4. That for all intents and purposes, aforesaid Passport is now

considered lost;

may serve and for the issuance of new Passport;

Pasig City.
ARMANDO NUŃEZ TABINAS
Affiant

______________at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, KINSKY HAZEL Q. CRYSTAL, of legal age, married, Filipino, and with

residence and postal address at no. 10 A. Santos St., Buting, Pasig City, after having
1. That I a holder of a Philippine Passport duly issued by the Department of

Foreign Affairs, Metro Manila;
2. That sometime in August, the said Passport was found missing,

presumably the same was misplaced;
avail;
4. That for all intents and purposes, aforesaid Passport is now considered
lost;

issuance of new Passport;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of Pasig
City.
KINSKY HAZEL Q. CRYSTAL
Affiant

______________at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, JOSIELYN G. TOLENTINO, of legal age, single, Filipino, and with residence

and postal address at 1425 martin Compound, Suarez St., Maybunga, Pasig City,
1. That I a holder of a Philippine Passport duly issued by the Department of

Foreign Affairs, Metro Manila;
2. That sometime in 2004, the said Passport was nowhere to be found in our
residence, presumably the same was misplaced;
avail;
4. That for all intents and purposes, aforesaid Passport is now considered
lost;


December 2008, Pasig City.
JOSIELYN G. TOLENTINO
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of December 2008 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, CHRISTINE ESPINO AKIYAMA, of legal age, married, Filipino, and residing

at 75 Green Palm St., Malinao, Pasig City, after having been duly sworn to in
1. I am a holder of Philippine Passport duly issued by the Department of

Foreign Affairs, Metro Manila issued on April 2009 and valid until April
2014;
2. I am a presently working and a permanent resident of Tokyo, Japan and I

was issued a Re-Entry Permit to Japan and now I am in vacation here in
the Philippines;
3. On September 1, 2012, when I was in Japan, the said Philippine Passport

was missing and nowhere to be found inside my bag, presumably it slipped
in the course of ordinary use thereof;
avail;
5. That for all intents and purposes, aforesaid Philippine Passport is now
considered lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 26 TH of September
2012 in Pasig City.
CHRISTINE ESPINO AKIYAMA

Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012

AFFIDAVIT OF LOSS
I, EDGARDO BALAISI, of legal age, Filipino, single, and with residence and
postal address at No. 520 P3 EBR Floodway, Sta. Lucia, Pasig City, after having

holder of 4 P’s I.D and;
2. That on sometime in August 2012, the said SSS digitized I.D. was found
missing and nowhere to be found in our residence, presumably the same
was misplaced;
avail;
considered lost;


__________, Pasig City.
MARK JIM S. DE GUZMAN

Affiant
SUBSCRIBED AND SWORN to before me this ____ day of ______________

at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012

AFFIDAVIT OF LOSS
I, DARIOS M. REPOZAR, of legal age, Filipino, and with residence and postal
address at No.270 Callejon 2 Sta. Cruz, Pasig City, after having been duly sworn to
1. That I am a holder of a Professional Driver's License issued by LTO,

Quezon City;
2. That last December 2013, my wallet containing the aforesaid Driver’s

License was stolen by unidentified person under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid Professional Driver’s License is

issuance of new Driver's License.;

________________2014, Pasig City.
DARIOS M. REPOZAR
Affiant

__________________ 2014 at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014.

AFFIDAVIT OF LOSS
I, RACQUEL FUENTES-CARUNCHO, of legal age, married, Filipino,

and with residence and postal address at 244 Dr. Sixto Antonio Ave.,
Caniogan, Pasig City, after having been duly sworn to in accordance with
law, hereby depose and say:
1. That I am the authorized CREATIVO ADVERTISING SOLUTIONS CO.,

the same located at the abovementioned address;
2. That said business was duly registered at Bureau of Internal

Revenue and accordingly I was issued a Certificate of
Registration;
3. That sometime on November 21, 2012, the said Certificate of

Registration was found missing, presumably the same was
misplaced;
but to no avail;
5. That for all intents and purposes, aforesaid Certificate of

Registration is now considered lost;

may serve;

_______Pasig City.
RACQUEL FUENTES-CARUNCHO
Affiant
SUBSCRIBED AND SWORN to before me this ____________ at Pasig

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.
AFFIDAVIT OF LOSS
I, ROBERT G. AVELLANO, of legal age, married, Filipino, and with

residence and postal address at B62 L6 P2 C3 KC-27 Karangalan Village,
Manggahan, Pasig City, after having been duly sworn to in accordance with
1. That I am the lawful owner of a motor vehicle by virtue of a Deed

of Absolute Sale executed by and between the undersigned and
SUPER TERMITE & PEST CONTROL, INC with Plate No. ZPY 243
issued by the Land Transportation office. Copy of which is hereto
attached for ready reference;
2. That sometime on November 12, 2013, at about 11:00 A.M while I

parked the aforesaid vehicle at the designated parking lot at
Cembo, Makati City, I noticed that its Plate Number was missing
presumably somebody took the same;
but to no avail;
5. That for all intents and purposes, the Plate Number of the
aforesaid motor vehicle issued by LTO is now considered lost;

may serve and for the issuance of new Plate Number by Land
Transportation Office;

_______Pasig City.
ROBERT G. AVELLANO
Affiant
City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, JOEVIC ANTHONY M. VILLARENTE, of legal age, single, Filipino,

and with residence and postal address at 413-I Molave St., Agapito
Subdivision, Santolan, Pasig City, after having been duly sworn to in
1. That I am the son of the late LUDIVECO A. VILLARENTE, who

died on November 16, 2012 at Santolan, Pasig City, being a
registered owner of a motor vehicle with Plate No. 9364NI, and
accordingly a holder of Certificate of Registration and Official
Receipt issued by the Land Transportation office;
2. That sometime on November 29, 2012, the original copy of the

said Certificate of Registration and Official Receipt of the above
motor vehicle of my late father, LUDIVECO A. VILLARENTE
was found missing, presumably the same was misplaced under
unknown circumstances;
but to no avail;
5. That for all intents and purposes, the original copy of the said
Certificate of Registration and Official Receipt of the motor
vehicle of my late father, LUDIVECO A. VILLARENTE issued by
LTO is now considered lost;

may serve and for the issuance of new Official Receipt and
Certificate of Registration by Land Transportation Office;

_______Pasig City.
JOEVIC ANTHONY M. VILLARENTE
Affiant
City.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, RODERICK BABASA MACAILAO, of legal age, single, Filipino, and

with residence and postal address at B2 L30 Ilocos St., Mangga II,
Pinagbuhatan, Pasig City, after having been duly sworn to in accordance
1. That I am the registered owner of a motor vehicle with Plate No.

UV 4129 and accordingly a holder of Franchise Plate No. 2010-
08395; City Plate No. 11-034 and other important documents of
the aforesaid vehicle issued by Tricycle Operation & Regulatory
Office of Pasig City ;
2. That sometime on July 08, 2013, the original copy of Franchise

Plate No. 2010-08395; City Plate No. 11-034 and other important
documents of the aforesaid vehicle issued by Tricycle Operation
& Regulatory Office of Pasig City was missing, presumably the
same was misplaced under unknown circumstances;
but to no avail;
4. That for all intents and purposes, the original copy of Franchise
Plate No. 2010-08395; City Plate No. 11-034 and other important
documents of the aforesaid vehicle issued by Tricycle Operation
& Regulatory Office of Pasig City are now considered lost;

may serve and for the issuance of the renewal of the franchise
of my aforesaid vehicle;

_______Pasig City.
RODERICK BABASA MACAILAO
Affiant
City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, NADIR C. ABRASIA, JR., of legal age, married, Filipino, and with residence
and postal address at 11 Vega Ville Urbano Velasco Ave., Pinagbuhatan, Pasig City,
1. That I am a registered owner of NADIR COMPURTER RENTALS located at

96 Urbano Velasco Ave., Pinagbuhatan, Pasig City;
2. That said business was registered at Bureau of Internal Revenue and

accordingly I was issued a Certificate of Registration;
3. That sometime on July 23, 2008, the said Certificate of Registration was
nowhere to be found in our residence, presumably the same was misplaced;
avail;
5. That for all intents and purposes, aforesaid Certificate of Registration is



NADIR C. ABRASIA, JR.

Affiant

Pasig City.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, NADIR C. ABRASIA, JR., of legal age, married, Filipino, and with residence
and postal address at 11 Vega Ville Urbano Velasco Ave., Pinagbuhatan, Pasig City,
1. That I am a registered owner of NADIR COMPURTER RENTALS located at

96 Urbano Velasco Ave., Pinagbuhatan, Pasig City;
2. That said business was registered at Bureau of Internal Revenue and

accordingly I was issued a Certificate of Registration;
3. That sometime on July 23, 2008, the said Certificate of Registration was
nowhere to be found in our residence, presumably the same was misplaced;
avail;
5. That for all intents and purposes, aforesaid Certificate of Registration is



NADIR C. ABRASIA, JR.

Affiant

Pasig City.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, OLIVA B. VEGA, of legal age, married, Filipino, and with residence and
postal address at U-311, Cattleya Condominium, R. Cruz St., Pinagbuhatan, Pasig
1. That I am presently employed with City Government of Pasig, Pasig City

detailed in Land Inventory & Recovery Unit and accordingly a holder of City
Hall I.D.
2. That sometime on January 5, 2006, the said I.D. was nowhere to be found
in our residence, presumably the same was misplaced;
avail;
4. That for all intents and purposes, aforesaid I.D. is now considered lost;

issuance of new I.D.;
IN WITPNESS WHEREOF, I have hereunto set my hand this 6th day of July
2006, Pasig City.
OLIVA B. VEGA
Affiant
SUBSCRIBED AND SWORN to before me this 11th day of July 2006 at Pasig
City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2006.

AFFIDAVIT OF LOSS
I, CELIA O. CRUZ, of legal age, married, Filipino, and with residence and
postal address at No. 36 Evangelista St., Santolan, Pasig City, after having been duly

detailed in City Health Office as Utility Worker and accordingly a holder of
City Hall I.D.
2. That sometime on October 10, 2008, while I was on board a passenger

jeep bound to Rosario, Pasig City, I noticed that the said I.D. was missing
avail;

IN WITPNESS WHEREOF, I have hereunto set my hand this 29th day of

October 2008 at Pasig City.
CELIA O. CRUZ
Affiant
SUBSCRIBED AND SWORN to before me this 29th day of October 2008 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, RICHARD B. ERMINA, of legal age, Filipino, and with residence and postal
address at No. 6 Villa Tupaz, San Joaquin Pasig City, after having been duly sworn
to in accordance with law, hereby depose and say:
1. I am presently employed with the City Government of Pasig, detailed at

City Records Office and accordingly in custody of the following documents
in the name Mercedita B. Saycon, to wit:
a. Employment Records.;
b. Real Property Tax Receipts;
c. Subsidiary Sales Journal issued by BIR;
d. Office Memorandums.;
e. Different Gasoline Receipts.;
f. Different Receipts (MRBS Garbage Hauling Services); and
g. Other Unidentified Important Documents;
2. On August 24, 2012, I noticed that the cabinet rack containing the said
documents were missing and nowhere to be found in our office,
avail;
4. That for all intents and purposes, aforesaid documents are now
considered lost;

IN WITNESS WHEREOF, I have hereunto set my hand this _______________

at Pasig City.
RICHARD B. ERMINA
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012

AFFIDAVIT OF LOSS
I, EVELYN MEDINA, of legal age, Filipino, married, and with residence and
postal address at No. 61-A Flores St., Bagong Ilog, Pasig City, after having been duly
1. That I am a holder of rights over a burial lot located at Barracks Cemetery,

Pasig City identified as Lot 1-B Niche #9 and was issued an Official
Receipts under the name of the late Enrique Mendoza, Jr buried on Jan
07, 2002 and the late Mary Jane Pablo buried on Sept 30, 2008 both at
Barracks Cemetery, Pasig City, respectively;
2. That yesterday, August 22, 2013, I noticed that the Official Receipts of the
aforesaid lot and other documents were missing and nowhere to be found
in our residence, presumably the same was washed away by flood during
typhoon “Ondoy”;
avail;
4. That for all intents and purposes, aforesaid documents are now considered
lost;

IN WITNESS WHEREOF, I have hereunto set my hand this _______________

at Pasig City.
EVELYN MEDINA
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013
AFFIDAVIT OF LOSS
I, ALICIA PAREDES SANTOS, of legal age, married, Filipino, and with

residence and postal address at No. 11 Turpentine Street, Greenwoods Executive
Village, Cainta Rizal, after having been duly sworn to in accordance with law, hereby
depose and say:
1. I am a Doctor by profession and a holder of Professional Regulations

Commission (PRC) License Card No. 71579;
2. On January 6, 2013, I noticed that PRC License Card was missing,

presumably it slipped off from my wallet in the course of ordinary use
thereof;
avail;
4. That for all intents and purposes, aforesaid Professional Regulations

Commission (PRC) License Card No. 71579 is now considered lost;

issuance of new PRC I.D.;

_______________ at Pasig City.
ALICIA PAREDES SANTOS

Affiant
Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, LEONISE DIMAANO BALAISI, of legal age, Filipino, and with

residence and postal address at 520 P3 EBR Floodway, Sta. Lucia, Pasig
depose and say:
1. That I am a holder of the following identifications, to wit:

a. 4 P’s I.D. and;
b. Yellow Card;
2. That on December 11, 2013, my wallet containing the

aforesaid IDs was accidentally slipped off from my pocket;

4. That for all intents and purposes, aforesaid identification cards

are now considered lost;

the foregoing facts, for all intents and for whatever legal purpose it may
serve and for the issuance of new Identification Cards;

_______________ at Pasig City.
LEONISE DIMAANO BALAISI

Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, JOHNNY LOUIE B. DEMETILLO, of legal age, Filipino, and with

residence and postal address at No. 2557 Josue St., Cent II, Nagpayong,
1. I am a holder of the following identification cards, to wit:
a Professional Driver’s License issued by LTO; and

b. SSS digitized I.D issued by Social Security System;
2. On September 4, 2013, , my wallet containing the aforesaid IDs

was accidentally slipped off from my pocket ;
but to no avail;
4. That for all intents and purposes, aforesaid identification cards

are now considered lost;

may serve and for the issuance of new Identification Cards;

_______________ at Pasig City.
JOHNNY LOUIE B. DEMETILLO

Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, DRA. CONCEPCION SJ. JIMENEZ, of legal age, Filipino, and with

residence and postal address at No. 37 G. Raymundo Street, Malinao, Pasig City,
1. I am presently employed with the City Government of Pasig, detailed at

Pasig City Health Office and accordingly a holder of the following
identification cards, to wit:
a GSIS UMID Card;

b. PRC ID- Doctor of Dental Medicine issued by Philippine Regulation
Commission ;
c. Philhealth I.D.;
d. Pasig Pateros Taguig Dental Chapter (PPTC) I.D.;
e. Malinao Barangay Card;
f. Voter’s ID issued by Comelec;
g. ATM Land Bank Card-E-plus; and
h. ATM Land Bank Card-E-plus
2. On December 08, 2012, while I was at Divisoria, Manila, I noticed that my

wallet containing the said Identification Cards was missing and nowhere to
be found, presumably it was taken by unknown persons under unknown
circumstances;
avail;
4. That for all intents and purposes, aforesaid identification cards are now
considered lost;

issuance of new Identification Cards;

_______________ at Pasig City.
DRA. CONCEPCION SJ. JIMENEZ

Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012

AFFIDAVIT OF LOSS
I, EDGARDO BALAISI, of legal age, Filipino, and with residence and postal
address at No. 520 P3 EBR Floodway, Sta. Lucia, Pasig City , after having been duly
1. That I am a bonafide member of Eusebio’s Angel and accordingly, I was

issued Identification card;
2. That sometime in December 11, 2013, I noticed that my wallet inside my
bag containing the said I.D. was missing presumably it was pickpocket by
unidentified person;
avail;

IN WITPNESS WHEREOF, I have hereunto set my hand this ________ at

Pasig City.
EDGARDO BALAISI
Affiant
SUBSCRIBED AND SWORN to before me this _______________ at Pasig

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, TERESITA B. EUGENIO, of legal age, Filipino, married, and with

residence and postal address at No. 50 A. B. Cruz St., Kalawaan, Pasig City,
and say:
1. That I am the mother and standing guardian of minor, REYNALYN
B. EUGENIO, who was graduated at San Joaquin -Kalawaan High
School, San Joaquin, Pasig City and accordingly a holder of the
following documents, to wit :
a. Form 137;;
b. Report Card; and
c. Good Moral Character; all issued by San Joaquin -Kalawaan
High School;
2. That last April 28 2012, the bag of my daughter containing the

aforesaid documents issued by San Joaquin -Kalawaan High
School, San Joaquin, Pasig City was taken by unknown persons
under unknown circumstances while she was on her way to Rizal
Technological University, Mandaluyong City;
but to no avail;
4. That for all intents and purposes, aforesaid documents of my

daughter are now considered lost;

may serve and for the issuance of the aforesaid documents;

Pasig City.
TERESITA B. EUGENIO
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, EMILIA I. BUMANLAG, of legal age, Filipino, married, and with

residence and postal address at No. 50 A. B. Cruz St., Kalawaan, Pasig City,
and say:
1. That I am the mother and standing guardian of minor, JAYMIE I.
BUMANLAG, who was graduated at San Joaquin -Kalawaan High
School, San Joaquin, Pasig City and accordingly a holder of the
following documents, to wit :
a. Report Card; and

b. Good Moral Character; both issued by San Joaquin
-Kalawaan High School;
2. That last April 28 2012, the bag of my daughter containing the

aforesaid documents issued by San Joaquin -Kalawaan High
School, San Joaquin, Pasig City was taken by unknown persons
under unknown circumstances while she was on her way to Rizal
Technological University, Mandaluyong City;
but to no avail;
4. That for all intents and purposes, aforesaid documents of my

daughter are now considered lost;

may serve and for the issuance of the aforesaid documents;

Pasig City.
EMILIA I. BUMANLAG
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013
AFFIDAVIT OF LOSS
I, LEONISE DIMAANO BALAISI, of legal age, Filipino, and with residence

and postal address at 520 P3 EBR Floodway, Sta. Lucia, Pasig City, after having
1. That on February 18, 2008, while I was driving my motorcycle along

Floodway, Maybunga, Pasig City, I noticed that my wallet containing the
following Identification Cards was missing, to wit:
a. SSS Digitized ID;;

b. E-Card issued by GSIS; and
d. Pag-Ibig Card;
2. . That diligent search and efforts were exerted to locate the same but to no
avail;
3. That for all intents and purposes, aforesaid I.D's. are now considered lost;


Pasig City.
JERRY A. CARBON
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009

AFFIDAVIT OF LOSS
I, MICHAEL B. ALMEDA, of legal age, married, Filipino, and with residence

and postal address at No. 38 C. Cruz St., Pinagbuhatan, Pasig City, after having
1. That I am presently employed with City Government of Pasig City detailed
in Pasig City General Hospital (PCGH);
2. That on December 13, 2008, around 6 o'clock in the evening, I parked my

motorcycle vehicle infront of Suarezville Clubhouse, I noticed that my
motorcycle's compartment was forcibly opened by unidentified persons and
my ID holder containing the following Identification Cards are missing, to
wit:
a. Employee I.D. issued by City Government of Pasig;

b. GSIS E-Card; and
c. Professional Driver's License issued by LTO;
presumably the same may have been taken by unknown person or

persons under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid I.D's. are now considered lost;


Pasig City.
MICHAEL B. ALMEDA
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, ALFREDO BUENAOBRA ALVAREZ., of legal age, Filipino, and with

residence and postal address at No. 287-B Dr. Sixto Antonio Avenue, Caniogan,
Pasig City, after having been duly sworn to in accordance with law, hereby depose
and say:
1. That I am a holder of the following identifications/documents, to wit:
a.) Non-Professional Driver’s License Card No. N01-08-023163;

b.) SSS I.D. Card with No. 03-8429804-6.
2. That sometime last month, I noticed that my abovementioned

identifications/documents were missing, presumably the same had been
slipped off my pocket in the course of ordinary use thereof;
avail;
4. That for all intents and purposes, aforesaid identifications/documents are


facts, for all intents and for whatever legal purpose;

Pasig City.
ALFREDO BUENAOBRA ALVAREZ

Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, MICHAEL BADUA, of legal age, Filipino, and with residence and postal
address at Lot 29 Blk. 29 Berlin St., Mercedez Village, San Miguel, Pasig City, after
1. Sometime in 2010, I bought one (1) unit of personal computer laptop

(ACER) from Market Market, Taguig City, and accordingly was issued
Official Receipt;
2. That said unit is covered of one (1) year warranty, but on November 12,
2008, I returned said unit because of defect (no power);
3. That PC Office, Inc. is requesting me for the official receipt as a proof of

purchase from their store, that recently my sister and I discovered that said
Official Receipt is nowhere to be found in our residence, presumably it was
misplaced;
avail;
5. That for all intents and purposes, aforesaid Official Receipt issued by PC
Office, Inc. is now considered lost;


Pasig City.
MICHAEL BADUA
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, MARY JANE G. BADDAL, of legal age, Filipino, and with residence and
postal address at No. 58 A.E. Mendoza St., Buting, Pasig City, after having been duly
1. That I am the brother of AMIE BADUA, the latter bought one (1) unit of
personal computer on first week of April, 2008, from PC Office, Inc. located
at 3/F Bldg. A, SM Megamall EDSA, Mandaluyong City, and accordingly
was issued Official Receipt;
2008, I returned said unit because of defect (no power);
3. That PC Office, Inc. is requesting me for the official receipt as a proof of

purchase from their store, that recently my sister and I discovered that said
misplaced;
avail;
5. That for all intents and purposes, aforesaid Official Receipt issued by PC
Office, Inc. is now considered lost;


Pasig City.
MARY JANE G. BADDAL

Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2010.

AFFIDAVIT OF LOSS
I, ALEJANE ESCRIBA, of legal age, Filipino, and with residence and postal
address at 372B Dr. Sixto Antonio Ave., Caniogan, Pasig City, after having been duly
1. That I bought one (1) unit of Samsung CT21Z5115 colored television with
Serial No. 12303VAS100054 and with IS No. 253506 on February 2, 2009
from SM Appliances located at G/F Bldg. B, SM Megamall EDSA,
Mandaluyong City, and accordingly I was issued Official Receipt;
2. That said unit is covered of one (1) year warranty, but last July 15, 2009,
said unit automatically turned off and now unserviceable;
3. That SM Appliance Center is requesting me for the official receipt as a

proof of purchase from their store, that recently I discovered that said
misplaced;
avail;
5. That for all intents and purposes, aforesaid Official Receipt issued by SM
Appliance Center is now considered lost;


Pasig City.
ALEJANE ESCRIBA
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, MAIDA M. FERNANDEZ, of legal age, Filipino, and with residence and

postal address at No. 553 Lopez Jaena St., Sumilang, Pasig City, after having been
1. That I bought one (1) unit of K770i Sony Ericsson cellular phone on May,
2008, from SM Appliances located at Basement Bldg. B, SM Megamall
EDSA, Mandaluyong City, and accordingly was issued Official Receipt;
2008, I returned said unit because of defect;
3. That SM Appliances is requesting me for the official receipt as a proof of

purchase from their store, that recently I discovered that said Official
Receipt is nowhere to be found in our residence, presumably it was
misplaced;
avail;
5. That for all intents and purposes, aforesaid Official Receipt issued by SM
Appliances. is now considered lost;


Pasig City.
MAIDA M. FERNANDEZ
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.
AFFIDAVIT OF LOSS
I, PRADO, of legal age, married, Filipino, and with

residence and postal address at _____________________________Pasig City, after

detailed in General Services Office and accordingly a holder of
Identification Card.
2. That sometime on September 13, 2007, the said I.D. was nowhere to be
found in our residence, presumably the same was misplaced;
avail;

IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of July
2006, Pasig City.
_______________PRADO
Affiant
SUBSCRIBED AND SWORN to before me this 6th day of July 2006 at Pasig
City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2006.

AFFIDAVIT OF LOSS
I, JAYSON B. DAGOHOY, of legal age, single, Filipino, and with

residence and postal address at Keneth, Block 11, Pinagbuhatan, Pasig
depose and say:
1. That I am previously employed at Stream Global Services Inc. and
accordingly a holder of company I.D.;
2. That sometime on July 11, 2013, I noticed that my wallet

containing the aforesaid company I.D. is missing and nowhere to
be found presumably it was slipped off from my pocket in the
course of ordinary use thereof;;
but to no avail;
4. That for all intents and purposes, aforesaid I.D. is now considered
lost;

may serve and for the issuance of new I.D.;

______________ day of February Pasig City.
JAYSON B. DAGOHOY
Affiant
SUBSCRIBED AND SWORN to before me this_____ day of February at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.
AFFIDAVIT OF LOSS
I, JOVITO MAGLENTE , of legal age, Filipino, and with residence and

postal address at No. 121 Carnation St. PFCI Brgy. San Andres, Cainta Rizal
and say:
1. That I am employed at G4S Cash Solution Phil. Inc with business

address at G4S House, 142 Pasig Blvd. Brgy Bagong Ilog, Pasig
City as an ATM Tech. (Teller) and accordingly I was issued a Cell
phone Unit Samsung G.T – E2230M;
2. That sometime last March 3, 2014, I was hold up by unknown

armed men using force and violence against me, they get may
Valuable things including the said Cell phone Unit Samsung G.T –
E2230M issued by G4S Cash Solution Phil. Inc;
but to no avail;
4. That for all intents and purposes, aforesaid Cell phone Unit
Samsung G.T – E2230M issued by G4S Cash Solution Phil. Inc is

may serve;

______________ day of January Pasig City.
JOVITO MAGLENTE
Affiant
SUBSCRIBED AND SWORN to before me this_____ day of February at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2014

AFFIDAVIT OF LOSS
I, MARK PAUL R. ALQUIZA, of legal age, single, Filipino, and with

residence and postal address at No. 10 Jasmin St., Cainta Greenpark
Village, Cainta, Rizal, after having been duly sworn to in accordance with
1. That I am presently employed at City Government of Pasig

detailed as Special Science Teacher I assigned at Pasig City
Science High School and accordingly a holder of UMID Card with
GSIS ID No. 82030500578 (BP Number 2000808251) and
PRC ID (Teachers License Card) with No. 0811050 ;
2. That recently I noticed that the aforesaid I.D.’s were nowhere to
be found in our residence, presumably the same were misplaced
under unknown circumstances;
but to no avail;
4. That for all intents and purposes, aforesaid I.D.’s are now
considered lost;

may serve and for the issuance of new I.Ds.;

______________ day of May 2013 Pasig City.
MARK PAUL R. ALQUIZA

Affiant
SUBSCRIBED AND SWORN to before me this_____ day of May 2013 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, LILIO B. LOBUSTA, of legal age, single, Filipino, and with

residence and postal address at No. 5224 Phase I, Ilugin, Pinagbuhatan,
depose and say:
1. That I am a holder of of UMID Card with GSIS ID No. CRN
006004952116 (BP Number 2003923086);
2. That recently I noticed that the aforesaid UMID I.D was nowhere
to be found in our residence, presumably the same were
but to no avail;
4. That for all intents and purposes, aforesaid I.D.’s are now
considered lost;

may serve and for the issuance of new I.Ds.;

______________ day of July 2013 Pasig City.
LILIO B. LOBUSTA
Affiant
SUBSCRIBED AND SWORN to before me this_____ day of July 2013 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, KATHERINE V. GRAY, of legal age, single, Filipino, and with residence and
postal address at 474 Blk. 9 Upper West Brgy. Pinagsama, Taguig City, after having
1. I am presently employed at AIMKOH, Jenny’s Ave., Rosario, Pasig City

and was issued a company I.D.;
2. On December 23, 2012, at Rizal High School, Pasig City, my bag

containing the said company I.D. was stolen by unidentified culprit;
avail;
4. That for all intents and purposes, aforesaid company I.D. issued by
AIMKOH is now considered lost;


________________, Pasig City.
KATHERINE V. GRAY
Affiant
SUBSCRIBED AND SWORN to before me this __________________ at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, MARIBETH V. GAMBOA, of legal age, married, Filipino, and with residence

and postal address at Blk. 9 West Floodway, Planters, Cainta, Rizal, after having
1. That I am a holder of a digitized Social Security System (SSS) ID with No.
________________ duly issued by the Social Security System, East
Aveneu, Diliman, Quezon City;
2. That sometime on January, 2006, I found out that my wallet is missing

presumably the same may have been taken by person or persons
unknown under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid ID is now considered lost;

issuance of new ID;
IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of March,
2006 at Pasig City.
MARIBETH V. GAMBOA
Affiant
SUBSCRIBED AND SWORN to before me this 8th day of March, 2006 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2006.

AFFIDAVIT OF LOSS
I, LILIO B. LOBUSTA, of legal age, Filipino, and with residence and postal
address at 5224 Phase I, Ilugin, Pinagbuhatan, Pasig City, after having been duly
2. That I am a holder of a Umid Social Security System (SSS) ID with No.


avail;

issuance of new ID;
IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of March,
2006 at Pasig City.
MARIBETH V. GAMBOA
Affiant
SUBSCRIBED AND SWORN to before me this 8th day of March, 2006 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2006.

AFFIDAVIT OF LOSS
I, RAMON F. FERNANDEZ, of legal age, married, Filipino, and with residence
and postal address at Kamatis St., Napico, Manggahan, Pasig City, after having been
1. That I am a holder of a Social Security System (SSS) ID with No.


avail;

issuance of new ID;
IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of

_____________, 2012 at Pasig City.
RAMON F. FERNANDEZ
Affiant
SUBSCRIBED AND SWORN to before me this 8th day of ________________

at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, CHESTER CARL PECO, of legal age, married, Filipino, and with residential
address at 672 Malvar Street, Manggahan, Pasig City, after having been duly sworn
1. That I am presently employed at Johnson and Johnson;
2. That I am in the possession of the original Invoice NO. 951003501 F2

dated February 24, 2012 in the amount of Php129,999.99;
3. That while in the process of facilitation of such invoice, I noticed that the
original copy of the said Invoice was missing, presumably the same had
been misplaced under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid Invoice No. 951003501 F2 is

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

_____________, 2013 at Pasig City.
CHESTER CARL PECO

Affiant
SUBSCRIBED AND SWORN to before me this 8th day of ________________

at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.
AFFIDAVIT OF LOSS
I, MA. TERESA C. MARCOS, of legal age, Filipino, and with

residence and postal address at No. 36 E. Jacinto St., Bambang, Pasig City,
and say:
1. That I am a registered voter at Brgy. Bambang, Pasig City and

accordingly a holder of Voter's Identification Card issued by
COMELEC;
2. That recently, October 30, 2013, I noticed that my wallet

containing the aforesaid Voter's Identification Card issued by
COMELEC was missing and nowhere to be found presumably it
slipped off from my pocket while I was riding in a tricycle going to
our house;
but to no avail;
4. That for all intents and purposes, aforesaid Voter’s I.D. is now
considered lost;
may serve and for the issuance of new ID;

July 2013 at Pasig City.
MA. TERESA C. MARCOS

Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, ALEJANDRO P. ZUÑO, JR. of legal age, Filipino, married, and with

residence and postal address at C. Raymundo Ave., Rosario, Pasig City,
and say:
1. That I am presently working at MOLLYSAN as a Driver and a

holder of Invoice No. 120000607847 dated November 09, 2013 sold to
EVER PLUS SUPERSTORE, INC San Mateo, Rizal Branch on the same date
by PEPSI COLA PRODUCTS PHILIPPINES, INC located at Km 29 National
Road, Brgy. Tunasan, Muntinlupa City and delivered the Pepsi Coca
Products as embodied in the aforesaid Invoice No. ;
2. That recently, I was informed by one of the personnel of Pepsi-

Cola Products Philippines, Inc ., that the Receiving Report/Receipt of the
aforesaid products under Invoice No, 120000607847 was missing and
nowhere to be found presumably it was misplaced in the ordinary use
thereof;
but to no avail;
4. That for all intents and purposes, aforesaid Receiving
Report/Receipt of the aforesaid products under Invoice No,

foregoing facts, for all intents and for whatever legal purpose it may
serve.
of _______________ at Pasig City.
ALEJANDRO P. ZUÑO, JR.
Affiant
SUBSCRIBED AND SWORN to before me this __________ at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, DIONISIO C. LACUNA, JR., of legal age, married, Filipino, and

with residence and postal address at No. 100 Sagad Pasig City, after
1. That I am a registered voter at Brgy. Sagad, Pasig City and

accordingly a holder of Voter's Identification Card issued by
COMELEC;
2. That last May 24, 2013, I noticed that my wallet containing the
aforesaid Voter's Identification Card issued by COMELEC was
missing and nowhere to be found presumably it was slipped off
from my pocket in the course of ordinary use thereof;
but to no avail;
4. That for all intents and purposes, aforesaid Voter’s I.D. is now
considered lost;

may serve and for the issuance of new ID;

June 2013 at Pasig City.
DIONISIO C. LACUNA, JR.

Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
We, MARTIN M. GUTIERREZ and FLORENCE E. GREGORIO, both of legal

age, Filipinos, and with office address at Unit G5 Warehouse 1, Armal Compound, C.
Raymundo Ave., Pasig City, after having been duly sworn to in accordance with law,
1. We are presently working at VINTEL LOGISTICS INC. as Customer

Service Specialist and Sales Admin Supervisor, respectively, and a holder of House
Way Bill (HBW) with No. 163473 and Delivery Order (DO) with No. 8058984007
under the name of Consignee, Metro Plaza Appliances located at 8000 DR. 1-3
Argaco Bldg., J.P. Laurel, Davao City;
2. On August 5, 2010, the aforesaid Delivery Order No. 8058984007 was

missing and nowhere to be found presumably it was misplaced when we are in
Davao City;
avail;
4. That for all intents and purposes, aforesaid Delivery Order No.
5. That we are executing this affidavit to attest to the veracity of the foregoing
IN WITNESS WHEREOF, we have hereunto set our hands this ____ day of
_______________ at Pasig City.
MARTIN M. GUTIERREZ FLORENCE E. GREGORIO

Affiant Affiant
SUBSCRIBED AND SWORN to before me this __________ at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2010.

AFFIDAVIT OF LOSS
I, ADRIAN DE LEON, of legal age, married, Filipino, and with residence and
postal address at 5321 Phase II, Block 7, Sitio Ilugin, Pinagbuhatan, Pasig City, after
1. That I am a holder of a Health Certificate Card issued by Sanitary

Office of Pasig City;
4. That sometime in September 26 2009 the said Health Certificate Card
was nowhere to be found in our residence, presumably the same was
misplaced;
3. That diligent search and efforts were exerted to locate the same but to
no avail;
4. That for all intents and purposes, aforesaid Health Certificate Card is

foregoing facts, for all intents and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of

ADRIAN DE LEON
Affiant
SUBSCRIBED AND SWORN to before me this __ day of October 2009 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.
AFFIDAVIT OF LOSS
I, DANIEL M. SAGUN, of legal age, Filipino, and with residence and postal
address at 1424 Suarez Cmpd. Maybunga, Pasig City, after having been duly sworn
1. That I was apprehended by Quezon City Traffic Enforcer for the

Violation of smoke Belching and accordingly I was issued a OVR;
2. That sometime in January 2011, I noticed that the aforesaid OVE was
missing presumably it was slipped off from my pocket in the course of
ordinary use thereof;
no avail;
4. That for all intents and purposes, aforesaid OVR is now considered lost;

serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ____________ at

Pasig City.
DANIEL M. SAGUN
Affiant
SUBSCRIBED AND SWORN to before me this _________________at Pasig

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, LITO S. DE VERA, of legal age, Filipino, and with residence and postal
address at No. 95 Market Ave., San Miguel, Pasig City, after having been duly
1. On July 23, 2013, I was apprehended by Pasig City Traffic Enforcer for
violation of Non-Use of Seat Belt and accordingly I was issued an
Official Violation Receipt (OVR);
2. On July 26, 2013, my wallet containing the aforesaid OVR was missing
and nowhere to be found, presumably it slipped off from my pocket in
the course of ordinary use thereof;
no avail;
4. That for all intents and purposes, aforesaid OVR issued by Pasig City
Traffic Enforcer is now considered lost;

serve.

Pasig City.
LITO S. DE VERA
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, TOTSIE M. UNAY, of legal age, Filipino, and with residence and postal
address at Lot 13 Block 2 Golden Home Subd., Sandoval Ave., Pinagbuhatan,
Pasig City after having been duly sworn to in accordance with law, hereby depose
and say:
1. That I purchased one BROTHER FAX MACHINE at Octagon Computer

RG, Quezon City on May 19, 2013;
2. That yesterday July 15, 2013, I noticed that Official Receipt for the
purchased of the said unit was missing and nowhere to be found
presumably the same was misplaced in the course of ordinary use
thereof;
3. Diligent search and efforts were exerted to locate the same but to no
avail;
4. For all intents and purposes, aforesaid Official Receipt is now

considered lost;
for all intents and for whatever legal purpose it may serve.

Pasig City.
TOTSIE M. UNAY
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013

AFFIDAVIT OF LOSS
I, JONEY LAURENTE., of legal age, Filipino, and with residence and postal
address at No. 20 URCC Road Veteran Center, Taguig City, after having been duly
1. That I am a holder of a Professional Driver's License Card and

Official Receipt issued by Land Transportation Office;
2. That on October 1, 2013, I noticed that my wallet, containing the

aforesaid Driver’s License Card and Official Receipt, was missing
presumably it was slipped off from my pocket in the course of ordinary
use thereof;
no avail;
4. That for all intents and purposes, aforesaid Professional Driver’s

License Card and Official Receipt are now considered lost;

serve.

Pasig City.
JONEY LAURENTE
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 20013
AFFIDAVIT OF LOSS
I, NELLY M. ANG, of legal age, widowed, Filipino, and with residence and
postal address at Kamagong St., Blue Diamond Subd., San Vicente, Sto. Tomas,
Pampanga,, after having been duly sworn to in accordance with law, hereby depose
and say:
1. That I am a registered Nurse by profession and a holder of a

Professional Identification Card with License No. 99125 issued by
Professional Regulation Commission, Manila;
2. That on December 17, 2007 at Pasig Public Market, I noticed that my

wallet inside my bag containing the said PRC I.D. was missing
presumably it was pickpocket by unidentified person;
no avail;
4. That for all intents and purposes, aforesaid PRC I.D. is now considered
lost;

serve.

________Pasig City.
NELLY M. ANG
Affiant
SUBSCRIBED AND SWORN to before me this __ day of ________ at Pasig

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.
AFFIDAVIT OF LOSS
I, ALFREDO MENDOZA INOCENCIO, of legal age, married, Filipino, and with

residence and postal address at 599 G. Legaspi St., Ugong, Pasig City, after having
1. I am a bonafide member of Social Security System and I was issued a

digitized SSS I.D. No. 03-1522856-4;
2. On October 2, 2012, I noticed that my wallet inside my bag containing

the said SSS digitized I.D. was missing presumably it was pickpocket
by unidentified person;
no avail;
4. That for all intents and purposes, aforesaid digitized SSS I.D. is now
considered lost;


________Pasig City.
ALFREDO MENDOZA INOCENCIO

Affiant

City.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2012

AFFIDAVIT OF LOSS
I, ESPERANZA C. BONETE, of legal age, married, Filipino, and with

residence and postal address at Unit K1 Venancio Caliwag St., , Pinagbuhatan,
and say:
1. That I am presently employed at the City Government of Pasig and

accordingly a holder of GSIS UMID CARD;
2. That on July, 2013, I noticed that my wallet inside my bag containing

the said GSIS UMID CARD was missing presumably the same was
misplaced;
no avail;
4. That for all intents and purposes, aforesaid GSIS UMID CARD is now
considered lost;


________Pasig City.
ESPERANZA C. BONETE
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013
AFFIDAVIT OF LOSS
I, ADRIAN DE LEON, of legal age, Filipino, and with residence and postal
address at 5321 Phase II, Block 7, Sitio Ilugin, Pinagbuhatan, Pasig City, after
1. That I am a holder of a Health Certificate Card issued by Sanitary

Office of Pasig City;
2. That sometime on August 30, 2008 at Pasig Public Market I noticed

that my Licensed was missing presumably misplaced;
no avail;
4. That for all intents and purposes, aforesaid Professional Drivers

Licensed is now considered lost;

serve.

_________ in Pasig City.
DANIEL GUTIERREZ
Affiant
SUBSCRIBED AND SWORN to before me this __ day of June 2008 at Pasig

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009
AFFIDAVIT OF LOSS
I, JENNIFER FIGUEROA QUIAMBAO, of legal age, single, Filipino, and with

residence and postal address at No. 3931 Cluster 5, Flexihomes, Rosario, Pasig
1. That I am a holder of a Certificate of Business Name Registration duly

issued by the Department of Trade and Industry;
2. That on September 26, 2009, during the occurrence of typhoon Ondoy,

I noticed that the documents including the above Certificate which was
placed in the cabinet located at the said business establishment was
submerged into the floodwater;
no avail;
4. That for all intents and purposes, aforesaid Certificate of Business

Name Registration duly issued by the Department of Trade and Industry
is now considered lost;

serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of -

_____________ Pasig City.
JENNIFER FIGUEROA QUIAMBAO

Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, ARNEL D. BACLAGAN, of legal age, married, Filipino, and with residence

and postal address at 5106 Ph. 1 Blk. 1, Ilugin, Pinagbuhatan, Pasig City, after
1. That I was a holder of a Professional Driver's License issued by

LTO-
San Juan;
2. That on December 12, 2008 at Makati City I noticed that my Driver's

License was missing presumably it was slipped off from my pocket;
no avail;

License is now considered lost;

serve.

_____________ Pasig City.
ARNEL D. BACLAGAN
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.

AFFIDAVIT OF LOSS
I, EDCEL GALLEGO SANGCO, of legal age, married, Filipino, and with

residence and postal address at Jasmin St., Pinagbuhatan, Pasig City, after having
1. That I am a holder of a Professional Driver's License issued by LTO,

Quezon City;
2. That on March 16, 2009 at Pinagbuhatan, Pasig City, I noticed that my

Driver's License was missing presumably it was slipped off from my
pocket;
no avail;

License is now considered lost;

serve.
_____________ Pasig City.
EDCEL GALLEGO SANGCO

Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.

AFFIDAVIT OF LOSS
I, JERRY MORENTE, of legal age, married, Filipino, and with residence and
postal address at Baltazar Street, Palatiw, Pasig City, after having been duly sworn to
1. That I am the registered and lawful owner of motor vehicle with Plate No.
PX 4210 and was issued a Certificate of Registration and Official Receipt
on November 14, 2005 by the Land Transportation Office, Diliman, Quezon
City, more particularly described as follows:
PLATE NO. PX 4210 MODEL 1996

TYPE OF BODY KAWASAKI COLOR BLACK
SERIAL NO. KB9018774 MOTOR NO. 528824
CLASSIFICATION PRIVATE
2. That sometime on June 16, 2005, while I’m on board a passenger
jeepney along Urbano Velasco Ave., Pinagbuhatan, Pasig City, I
noticed that my envelope together with my other documents such as
Certificate of Registration and Official Receipt of said vehicle were missing;
no avail;
4. That for all intents and purposes, aforesaid CR and OR of my motor

vehicle is now considered lost;

foregoing facts, for all intents and for whatever legal purpose it may serve
and for the issuance of new CR and OR of my motor vehicle;
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of July
2006, Pasig City.
JERRY MORENTE
Affiant
SUBSCRIBED AND SWORN to before me this __ day of July 2006 at Pasig
City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2006.

AFFIDAVIT OF LOSS
I, ABELARDO BORJA ALMACHAR, JR., of legal age, married, Filipino, and

with residence and postal address at No. 43 F. Jose Felicano St., Sagad, Pasig City,
1. That I am the registered and lawful owner of firearm with firearm holder No.
M1911FS.9MM Armscor pistol with serial No. 1224734 and was issued a
Firearm License;
2. That sometime on August 24, 2012, I discovered that my attaché case

containing said firearm , magazine assembly and ammunitions, insurance
policy, proof of purchase and other allied documents pertaining to said
firearm were lost presumably the same was missing inside their master’s
bedroom because of the ongoing house renovation:
no avail;
4. That for all intents and purposes, aforesaid attaché case containing said
firearm , magazine assembly and ammunitions, insurance policy, proof of
purchase and other allied documents are now considered lost;


ABELARDO BORJA ALMACHAR,

JR.
Affiant
SUBSCRIBED AND SWORN to before me this __ day of September 2012 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, MYLA S. ADEA, of legal age, married, Filipino, and with residence and
postal address at 12 Rosario Village, Rosario, Pasig City, after having been duly
1. I am presently employed with the City Government of Pasig and

accordingly, a holder of the following Identification Cards, to wit:
a. GSIS E-Card;
b. Pag-Ibig I.D.; and
c. Philhealth I.D.;
2. On August 8, 2012, I noticed that my wallet containing the aforesaid
Identification Cards was missing and nowhere to be found in our residence,
presumably it was taken by unidentified culprit;
avail;
4. That for all intents and purposes, aforesaid Identification Cards are now
considered lost;


of______________, Pasig City.
MYLA S. ADEA
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, VIRGINIA G. TUSCANO, of legal age, widow, Filipino, and with residence

and postal address at Lot 24, Block 3, Villa Maria Subdivision, Cupang, Antipolo City,
1. That I am an employee of Commission on Elections and detailed at

Second District, Pasig City and a holder of GSIS eCard duly issued by the
Government Service Insurance System (GSIS);
2. That sometime on March 7, 2007 when I was in a passenger jeepney going

to my house in Antipolo, I found out that my wallet where I put my GSIS eCard is
missing presumably the same may have been taken by person or persons
avail;
4. That for all intents and purposes, aforesaid GSIS eCard is now considered
lost;

issuance of GSIS eCard.;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of March
2007, Pasig City.
VIRGINIA G. TUSCANO
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2007.

AFFIDAVIT OF LOSS
I, MICHELLE A. FAJEL, of legal age, married, Filipino, and with residence

and postal address at 34-B Villa Silva, Palatiw, Pasig City, after having been duly
1. That I graduated high school from Rizal High School, Caniogan, Pasig
City sometime in year 1997 and accordingly was issued a High School
Diploma;
2. That sometime in February 2009 the said diploma was nowhere to be

found in our residence, presumably the same was misplaced;
no avail;
4. That for all intents and purposes, aforesaid diploma under my maiden
name VIRGIE G. LARANAN is now considered lost;

serve;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of May
Pasig City.
VIRGIE G. LARANAN-LAÑO
Affiant
SUBSCRIBED AND SWORN to before me this day of _________at Pasig

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.

AFFIDAVIT OF LOSS
I, MILDRED REYES LAVADO, of legal age, married, Filipino, and with

residence and postal address at No. 1 Reinosa St., Phase 9B, Vista Verde Exec.
Village, Cainta, Rizal, after having been duly sworn to in accordance with law, hereby
depose and say:
1. I graduated college at Pasig Catholic College (PCC) sometime in year

1996 and accordingly was issued a College Diploma;
2. On September 26, 2009, due to typhoon “Ondoy” our community and

our house were flooded and the said College Diploma was affected by
the said calamity;
no avail;
4. That for all intents and purposes, aforesaid diploma under my maiden
name MILDRED B. REYES is now considered lost;

serve;
Pasig City.
MILDRED REYES LAVADO

Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012

AFFIDAVIT OF LOSS
I, AMY K. ORDIZ, of legal age, Filipino, and with residence and postal address
at No. 71 Romantic Village, Ibayo Sta. Ana, Taguig City, after having been duly sworn
1. I finished my secondary education at Rizal High School, Caniogan,

Pasig City sometime in year 1990 and accordingly I was issued a High
School Diploma;
2. On September 26, 2009, due to typhoon “Ondoy” our community and

our house were flooded and the said High School Diploma was affected
by the said calamity;
no avail;
4. That for all intents and purposes, aforesaid High School Diploma is now
considered lost;
5. I am executing this affidavit to attest to the veracity of the foregoing

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

Pasig City.
AMY K. ORDIZ
Affiant

City.
Doc. No. ___0;

Page No. ___;
Book No. ___;
Series of 2011

AFFIDAVIT OF LOSS
I, JASMINE C. QAMAR, of legal age, married, Filipino, and with residence

and postal address at 39 Sitio Buli, San Miguel, Pasig City, after having been duly
1. That I am the mother of ABDUL GUDO C. QAMAR, a 1st year high

school student of Capitolyo High School and he was issued a school
Report Card;
2. That sometime in December 2008, when I was in Makati High School,

the said Report Card was missing and nowhere to be found,
no avail;
4. That for all intents and purposes, aforesaid school Report Card of my
son Abdul Gudo C. Qamar is now considered lost;

serve;
Pasig City.
JASMINE C. QAMAR
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.

AFFIDAVIT OF LOSS
I, ROGELIO M. ILOCSO, JR., of legal age, married, Filipino, and with

residence and postal address at 353-A Dr. Sixto Antonio Ave., Caniogan, Pasig City,
1. That I graduated high school at Rizal High School, Caniogan, Pasig

City sometime in year 2007 and accordingly was issued a Form 138
and Certificate of Good Moral Character;
2. That sometime in May 2008 the said Form 138 and Certificate of Good
Moral Character were nowhere to be found in our residence,
no avail;
4. That for all intents and purposes, aforesaid Form 138 and Certificate of
Good Moral Character are now considered lost;

serve;
Pasig City.
ROGELIO M. ILOCSO, JR.

Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.

AFFIDAVIT OF LOSS
I, KHRISTINA F. CABANGISAN, of legal age, single, Filipino, and with

residence and postal address at 14611 Mahogany St., Eusebio Ave., Nagpayong II,
Pinagbuhatan, Pasig City, after having been duly sworn to in accordance with law,
1. That I graduated college at Pamantasan ng Lunsod ng Pasig sometime

in year 2004 and a holder of school identification card;
2. That sometime in December 2008, the said school I.D. was nowhere to
be found in our residence, presumably the same was misplaced;
no avail;
4. That for all intents and purposes, aforesaid school I.D. is now
considered lost;

serve;
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of Pasig
City.
KHRISTINA F. CABANGISAN
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.

AFFIDAVIT OF LOSS
I, ESPERANZA V. VICTORIA, of legal age, widow, Filipino, and with residence

and postal address at 137 Dr. Sixto Antonio Ave., Maybunga, Pasig City, after having
1. That I am one of the stock holder of Philippine Long Distance Telephone

Company and accordingly was issued Certificate of Stock Holder;
2. That sometime in October 2008, the said Certificate was nowhere to be

found in our residence presumably the same was misplaced;
avail;
4. That for all intents and purposes, aforesaid Certificate is now considered
lost;


ESPERANZA V. VICTORIA
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of December 2008

at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
1, MONINA S. DAQUIZ, of legal age, Filipino, and with residence and postal
address at I LVM Townhouse, 9 De Pebrero St., Mandaluyon City, after having been
1. That I am presently working as Account Specialist at Snow Mountain Dairy

Corporation, Pasig City and a holder of Sales Invoice No. 34554 ;
2. That sometime on November 17, 2008, the aforesaid Sales Invoice No.
34554 was nowhere to be found at MCDI Office, Sandoval Ave., Pinagbuhatanm
Pasig City, presumably the same was misplaced under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid Sales Invoice No. 34554 is


MONINA S. DAQUIZ
Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2007.

AFFIDAVIT OF LOSS
I, JOCELYN D. PANGAN, of legal age, married, Filipino, and with residence

and postal address at 414 B, Dr. Sixto Antonio Avenue, Maybunga, Pasig City, after
1. That I am a holder of an SSS ID with No. 03- 8191623-7 duly issued by

Social Security System;
2. That sometime on May 4, 2007, the said I.D. was nowhere to be found
in our residence, presumably the same was misplaced;
no avail;

serve and for the issuance of new I.D.;
2007, Pasig City.
JOCELYN D. PANGAN
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of May 2007 at Pasig
City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2007.
AFFIDAVIT OF LOSS
I, RENATO REYES LUZANA, JR., of legal age, married, Filipino, and with
residence and postal address at #9A Main St., Isla Homes II $ III, Pinagbuhatan,
and say:
1. That I graduated high school from Rizal High School, Kapitolyo, Pasig
City sometime in year 2002 and accordingly was issued a High School
Diploma;
2. That sometime in October 31, 2002 the said diploma was nowhere to
be found in our residence, presumably the same was misplaced;
no avail;
4. That for all intents and purposes, aforesaid diploma is now considered
lost;

serve;
Pasig City.
RENATO REYES LUZANA, JR.

Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.
AFFIDAVIT OF LOSS
I, GERALDINE A. ABUNGAN, of legal age, Filipino, married, and

with residence and postal address at No.2-II Anońas St., Suarezville Subd.,
1. That I am a plan holder of Blue Cross Health Card with No.

4649668274217010;
2. That sometime last week, the said health card was nowhere to
be found in our residence presumably the same was misplaced
under unknown circumstances;

4. That for all intents and purposes, aforesaid health card is now
considered lost;

the foregoing facts, for all intents and for whatever legal
purpose it may serve and for the issuance of new Health Card;

________________, Pasig City.
GERALDINE A. ABUNGAN
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of _____________

at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

AFFIDAVIT OF LOSS
I, GIOVANNI D. MECALLER, of legal age, Filipino, and with residence and

postal address at Abnai Lupang Arienda, Taytay Rizal, after having been duly sworn
1. That I graduated from Rizal High School sometime in year 1992 and
accordingly a holder of High School Diploma;
2. That sometime in 2004 the said diploma was nowhere to be found in

our residence, presumably the same was misplaced;
no avail;
4. That for all intents and purposes, aforesaid diploma is now considered
lost;

serve;
Pasig City.
GIOVANNI D. MECALLER
Affiant

City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, EMMANETTE B. BARON, of legal age, married, Filipino, and with residence

and postal address at Block 51, Lot 3, Kaibigan St., Karangalan Village, Manggahan,
and say:
1. That I am a holder of Pawn Ticket Numbers .more particularly described as

follows:
(a) PT No. : 24797
Description : Pulcera
18 K; 6.1 gms.
Principal # : 4880
Loan Date : April 12, 2007
(b) PT No. : 26550
Description : Earrings
18 K; 2.4 gms.
Principal # : 2000
Loan Date : June 22, 2007
issued by Cebuana Lhuilier, Santolan Branch, Pasig City;
2. That sometime on July 22, 2007, when I was in a passenger jeepney going
to my house in Manggahan, Pasig City, I found out that my wallet where I
put said Pawn Tickets are missing presumably the same may have been
taken by person or persons unknown under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid Pawn Ticket are now
considered lost;

IN WITNESS WHEREOF, I have hereunto set my hand this____day of

EMMANETTE B. BARON
Affiant
SUBSCRIBED AND SWORN to before me this ______th day of September
2007 at Pasig City.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2007.
AFFIDAVIT OF LOSS
(Pawn Ticket)
I, VHON CEDRICK G. CANTACO, of legal age, Filipino, and with residence

and postal address at Tuazob Compd, San Miguel, Pasig City, after having been duly
1. On December 6, 2012, I pawned at Palawan Pawnshop, , my one (1)

cellphone SAMSUNG S3353 in the amount of Five Hundred (P500.00)
Pesos and accordingly I was issued a Pawn Ticket;
2. Sometime in December 7, 2012, the aforesaid pawn ticket was

inadvertently lost, presumably the same was misplaced;
avail;
lost;

IN WITNESS WHEREOF, I have hereunto set my hand this____ at Pasig City.
VHON CEDRICK G. CANTACO

Affiant
SUBSCRIBED AND SWORN to before me this ______ at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
(Pawn Ticket)
I, MERLYN Q. MURCHIA, of legal age, married, Filipino, and with residence

and postal address at 3413 Peter Ali Comp., C. Raymundo Ave., Rosario, Pasig City,
1. On August 20, 2010, I pawned at Agencia De Empeños De Estela

Raymundo Legaspi, Inc., Kapasigan, Pasig City, my one (1) Pendant w/
Des Scrtch Dscl Def. in the amount of Fifteen Thousand (P15,000.00)
Pesos and accordingly I was issued a Pawn Ticket with No. 309027;
2. Sometime in November 2010, when I was looking for the said Pawn Ticket,
I noticed that it was missing and nowhere to be found, presumably it was
avail;
lost;

IN WITNESS WHEREOF, I have hereunto set my hand this____ at Pasig City.

MERLYN Q. MURCHIA
Affiant
SUBSCRIBED AND SWORN to before me this ______th day of September

2010 at Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2010

AFFIDAVIT OF LOSS
I, VALERIE A. COMPANERO, of legal age, Filipino, and with residence and

postal address at No. 3 Corallane St. Vista Verde Country Homes, Cainta, Rizal, after
1. That I am a holder of an SSS ID with No. 33- 5010438-1 duly issued by

Social Security System;
2. That sometime on October 23, 2007, the said SSS ID was nowhere to be
found in our office, presumably the same was misplaced;
no avail;
4. That for all intents and purposes, aforesaid SSS ID is now considered lost;
. That I am executing this affidavit to attest to the veracity of the

foregoing facts, for all intents and for whatever legal purpose it may serve
and for the issuance of new ID;

November 2007, Pasig City.
VALERIE A. COMPANERO
Affiant
SUBSCRIBED AND SWORN to before me this __ day of November 2007, at
Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2007.

AFFIDAVIT OF LOSS
I, DANILO B. IRLANDEZ, of legal age, Filipino, and with residence and postal
address at No. Road 10 Lot 10 Brgy. Sta. Ana, Taytay Rizal, after having been duly
1. That I am a holder of a Student’s License issued by the Land

Transportation Office, Kapitolyo, Pasig City;
2. That sometime on June 10, 2009, I noticed that my wallet containing

among others the said Student’s License was missing inside the
compartment of my motor vehicle, presumably the same may had been
taken against the said compartment with intent to gain;
avail;
4. That for all intents and purposes, aforesaid Student’s License is now
considered lost;

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

___________ , Pasig City.
DANILO B. IRLANDEZ
Affiant
SUBSCRIBED AND SWORN to before me this ___ day of _____________ , at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2009.

AFFIDAVIT OF LOSS
I, JOEARCY CALPITO y DACQIEL, of legal age, Filipino, single, and with

residence and postal address at District 1, Benito Soliven, Isabela, after having been
1. That I am a holder of a Professional Driver's License issued by the Land

Transportation Office, Cauayan, Isabela;
2. That sometime on September 2003, when I was in a passenger jeepney

going to my house at B. Soliven, Isabela, I found out that my wallet where I
put said Driver's License is missing presumably the same may have been
no avail;
4. That for all intents and purposes, aforesaid Driver's License is now
considered lost;

issuance of new Driver's License;
JOEARCY CALPITO y DACQIEL

Affiant
SUBSCRIBED AND SWORN to before me this __ day of January 2008, at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, NORBERTO TORRES MALICDEM, of legal age, Filipino, married, and with

residence and postal address at No. 15 Sgt. Santos St., Bagong Ilog, Pasig City,
1. I am a professional driver and a holder of Professional Driver's License

issued by the Land Transportation Office (LTO);
2. On December 2, 2012, I found out that my Driver’s License where I put

inside my bag was missing and nowhere to be found, presumably it slipped
off or misplaced under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid Professional Driver's License is

facts, for all intents and for whatever legal purpose it may serve and for
the issuance of new Driver's License;
NORBERTO TORRES MALICDEM

Affiant
CTC No. 01688295
Issued on 12/4/2012 at Pasig City
SUBSCRIBED AND SWORN to before me this __ day of December 2012, at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2012.

AFFIDAVIT OF LOSS
I, JOEARCY CALPITO y DACQIEL, of legal age, Filipino, single, and with

residence and postal address at District 1, Benito Soliven, Isabela, after having been
1. That I am a holder of a Professional Driver's License issued by the Land

Transportation Office, Cauayan, Isabela;
2. That sometime on September 2003, when I was in a passenger jeepney

going to my house at B. Soliven, Isabela, I found out that my wallet where I
put said Driver's License is missing presumably the same may have been
no avail;
4. That for all intents and purposes, aforesaid Driver's License is now
considered lost;

issuance of new Driver's License;

JOEARCY CALPITO y DACQIEL

Affiant
SUBSCRIBED AND SWORN to before me this __ day of January 2008, at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, ANALYN F. DELOS SANTOS, of legal age, Filipino, and with residence and
postal address at 1217 Callejon 12 , Pasig City, after having been duly sworn to in
1. That I am a holder of Voter's I.D. issued by the Commission on Election;
2. That sometime on February 17, 2008, I found out that my wallet where I
put said Voter's ID is missing presumably the same may have been taken
by person or persons unknown under unknown circumstances;
avail;
4. That for all intents and purposes, aforesaid Voter's I.D. is now considered
lost;

issuance of new Voter's I.D.;
IN WITNESS WHEREOF, I have hereunto set my hand this __th day of July
2008, Pasig City.
MARIA FATIMA C. DELA CRUZ

Affiant
SUBSCRIBED AND SWORN to before me this ___ th day of July 2008 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, ANALYN F. DELOS SANTOS, of legal age, married, Filipino, and with

residence and postal address at 1217 Callejon 12 Martin Compound, Maybunga,
and say:
1. That I am a holder of an ATM Card issued by Banco De Oro, Rosario,

Pasig City;
2. That sometime on September 14, 2008, the said ATM card was nowhere
to be found in my possession, presumably the same was misplaced;
avail;
lost;

ANALYN F. DELOS SANTOS

Affiant
SUBSCRIBED AND SWORN to before me this 17th day of September 2008 at

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2008.

AFFIDAVIT OF LOSS
I, GREGORIO N. ARZAGA, SR., of legal age, Filipino, and with residence

and postal address at No. 045 Villa Topaz, San Joaquin, Pasig City, after having
1. I am presently employed with the City Government of Pasig and

accordingly a holder of an ATM card issued by LANDBANK, Pasig City Hall
Extension Office ;
2. On July 25, 2013, while I was at our house, I noticed that my wallet
containing the aforesaid ATM was lost presumably it was misplaced under
unknown circumstances ;
avail;
lost;

issuance of new ATM Card;

_______________ at Pasig City.
GREGORIO N. ARZAGA, SR.

Affiant

Pasig City.
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.

Ondoy

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Ondoy

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REPUBLIC OF THE PHILIPPINES)

CITY OF PASIG )S. S.

I, GIRLEY T. DELA CRUZ, of legal age, married, Filipino, and

2. That on March 27, 2014 around 5:30 pm to 6:00pm , while I

3. That diligent search and efforts were exerted to locate the

4. That for all intents and purposes, aforesaid apple i-phone is

5. That I am executing this affidavit to attest to the veracity of

IN WITPNESS WHEREOF, I have hereunto set my hand this

GIRLEY T. DELA CRUZ

SUBSCRIBED AND SWORN to before me this ___________________ at

Doc. No. ___;

I, ANTONIO D. ALTEZA, of legal age, Filipino, and with residence

1. That I am a holder of a Philippine Passport duly issued by the

2. That during the typhoon “Ondoy” on September 26, 2009, our

4. That for all intents and purposes, aforesaid Passport is now

5. That I am executing this affidavit to attest to the veracity of the

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

SUBSCRIBED AND SWORN to before me this ____ day of

Doc. No. ___;

I, JOSEPH MABALAY BITANGCOL, of legal age, Filipino, and with

1. I was previously employed at ABS-CBN and accordingly I was

2. That during the typhoon “Ondoy” on September 26, 2009, our

4. I am executing this affidavit to attest to the veracity of the

JOSEPH MABALAY BITANGCOL

SUBSCRIBED AND SWORN to before me this ____ day of at Pasig City.

Doc. No. ___;

REPUBLIC OF THE PHILIPPINES)

I, MERDAN M. BALERITE, of legal age, Filipino, and with residence and

1. That I am a holder of an ATM Card issued by BPI Family Savings Bank,

5. That I am executing this affidavit to attest to the veracity of the foregoing

IN WITNESS WHEREOF, I have hereunto set my hand this 19th day of

SUBSCRIBED AND SWORN to before me this 19th day of September 2013 at

Doc. No. ___;

REPUBLIC OF THE PHILIPPINES)

I, ELVIRA V. VARGAS, of legal age, Filipino, and with office address

1. That I am presently employed at City Government of Pasig

2. That sometime last week of October 2013 while I was on my sick

5. That I am executing this affidavit to attest to the veracity of the

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

Doc. No. ___;

REPUBLIC OF THE PHILIPPINES)

I, HECTOR P. CAJAPIN, of legal age, married, Filipino, and with

1. That I am one of the surviving children of the late Spouses

2. Sometime on year 1995 while I was sorting our documents, I

4. For all intents and purposes, aforesaid Cancellation and Release

5. I am executing this affidavit to attest to the veracity of the

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

SUBSCRIBED AND SWORN to before me this ____ day of at Pasig City.

Doc. No. ___;

REPUBLIC OF THE PHILIPPINES)

2. Sometime on November 27, 20013, while I was driving my motor

4. For all intents and purposes, aforesaid envelope containing the

5. I am executing this affidavit to attest to the veracity of the

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

REPUBLIC OF THE PHILIPPINES)

I, JOYCE T. FAMULARCANO, of legal age, single, Filipino, and with

1. I am presently undergoing Pasig Livelihood Foundation Inc. at the Gender

5. I am executing this affidavit to attest to the veracity of the foregoing facts,

SUBSCRIBED AND SWORN to before me this ____ day of at Pasig City.

Doc. No. ___;

REPUBLIC OF THE PHILIPPINES)

I, HAZEL A. RESAGA, of legal age, married, Filipino, and with

1. I am presently employed at Commander Security Services, Inc. as

SUBSCRIBED AND SWORN to before me this _ day of ____ at

SUBSCRIBED AND SWORN to before me this _ day of ____ at