REPUBLIC OF THE PHILIPPINES )

__________________________)S.S.

AFFIDAVIT OF LOSS
I, _____________________, of legal age, single/married, Filipino, and a resident of
________________________________________, after having been duly sworn to in accordance
with law, depose and say:

1. That I am a bona fide holder a Postal Identification Card issued by Philippine Postal
Corporation;

2. That I usually place the above-mentioned Identification Card inside my card holder;

3. That the aforesaid card holder containing the above-mentioned Postal Identification Card
for unknown reason is now missing and can no longer be located;

4. That despite diligent effort has been made to look for the said identification card but
proved futile and must therefore considered it lost for all intents and purposes;

5. That I am executing this Affidavit of Loss to attest to the truthfulness of the foregoing
statements made and for all other legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of _______ at the
City of ________________.

______________________
Affiant

SUBSCRIBE AND SWORN to before me this ___ day of _______ at the City of
________________.

NOTARY PUBLIC

Doc. No.
Page No.
Book No.
Series of 2019.