REPUBLIC OF THE PHILIPPINES )

Tagum City ) S.S

Davao del Norte )
x-------------------------x

AFFIDAVIT OF LOSS

I, FREDDIE C. CASTRO of legal age, Filipino, married and a resident of

Garciaville Subdivision, Brgy. Mankilam, Tagum City, Philippines, after
having been duly sworn to an oath in accordance with law hereby
depose and say THAT;

1. I am a Public School Teacher at Tagum City National High School and

a bona fide member of Government Service Insurance System;

2. As such I was issued a Unified Membership Identification Card (UMID) in

my name by the above-mentioned government agency, Tagum City
Branch;

3. The said UMID CARD was safely kept in my wallet;

4. However, sometime on October, 2018 , I noticed that the same was no

longer in my wallet and nowhere to be found;

5. I exerted diligent efforts to locate it but the same proved futile. For this
reason, it is considered lost beyond recovery;

6. I am executing this Affidavit to attest to the truth and veracity of the

foregoing statements and to apprise the proper authorities concerned
on the matter for their information and guidance for the issuance of a
UMID Card and whatever legal purpose/s this may serve best.

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

__________________ at _________________________, Philippines.

FREDDIE C. CASTRO
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of

________________________at ________________________, Philippines.

Doc. No. ____;

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