REPUBLIC OF THE PHILIPPINES)

BALAGTAS, BULACAN ) s.s.

x-----------------------------------------x

AFFIDAVIT OF LOSS

I, SUSANA SANCHEZ REYES, of legal age, Filipino citizen, widow and

presently residing at 358 M. Ajose St., San Juan, Balagtas, Bulacan, after having
been sworn in accordance with law, do hereby depose and say that:

1. I am a holder of COMELEC ID with VIN#1402-0140E-

K1365SSR2000-8 and Unified Multi-purpose ID with CRN# 006-
0058-3929-1.

2. However, on July 2, 2018, I discovered that the above

mentioned ID’s were missing.

3. I exerted earnest effort to locate the same but to no avail.

4. I executed this Affidavit to attest to the truth of the foregoing

and for whatever purpose it may legally serve. Especially to seek
replacement of the above-mentioned ID’s.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 3rd day of

July 2018 hereat Balagtas, Bulacan.

SUSANA SANCHEZ REYES

Affiant

SUBSCRIBED AND SWORN TO before me this 3rd day of July 2018 hereat
Balagtas, Bulacan.

WITNESS MY HAND AND SEAL.

Doc. No.: ____;

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