REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LAGUNA)
MUNICIPALITY OF CALAUAN ) S. S.

AFFIDAVIT OF LOSS

I, JOCELYN LOVERITA ACERO, widow, Filipino, of legal age, and with

postal address at Labuin, Santa Cruz, Laguna, after having duly sworn to in accordance
with law, do hereby depose and state:

1. That I have been issued by the St. Peter Life Plan, Inc. San Pablo
an Contract and Policy Card with Contract No: L14219178E;

2. That I discovered that my Contract and Policy Card is missing;

3. That notwithstanding thorough and diligent efforts that I have exerted to

locate my Contract and Policy Card, I could not find it nor locate the same
and in all probability the same has been lost and can no longer be
recovered;

4. That I executed this Affidavit to attest to the fact of loss to the St. Peter
Life Plan, Inc. San Pablo and for whatever other legal purpose this may
serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 24 th

day of September 2019 at Calauan, Laguna.

JOCELYN LOVERITA ACERO

Affiant
UMID: 006-0113-8251-7

SUBSCRIBED AND SWORN to before me a Notary Public for the Municipality of

Calauan, Bay, Los Banos and in the City of Calamba Laguna with office address at 2/F,
Villaran Building, Alvela St., Brgy. Kanluran Calauan Laguna, this 24 th day of September
2019 personally appeared the above named affiant showing to me his ID and avows
under penalty of law to the whole truth of the contents thereof.

ATTY. ALDRIN P. ALIMBUYOG

NOTARY PUBLIC
2F, Villaran Building, Alvela St. Brgy. Kanluran,
Calauan,Laguna
Roll. No. 73376
Doc. No. _______ IBP. 088585/LAGUNA
Page No. _______ PTR No. 7391498 /07-09-19 / Calauan, Laguna
Book No._______ MCLE: Newly admitted to the BAR
Series of 2019 Email Address; aldrinalimbuyog1@gmail.com
Cellular Phone No. 09565207359