REPUBLIC OF THE PHILIPPINES )

CITY OF ROXAS ) SS.

AFFIDAVIT OF LOSS OF IDENTIFICATION CARD

I, FORTUNATO M. BUTALON, Filipino, of legal age, married to

_Mariafe A. Butalon____, and a resident of Brgy. Sinabsaban,
Cuartero, Capiz, after having been duly sworn in accordance with
law, hereby depose and say:

1. That I am a holder of a Voter’s identification card issued by

Commission on Election;

2. That I used to put said ID Card in my wallet;

3. That sometime on September 8, 2019, when I arrived home

from work, I discovered that my wallet including my Voter’s
ID was lost;

4. That I probably lost it when I was travelling from work going

home;

5. That diligent effort to locate and search in places where I

have been on that day, said ID was nowhere to be found;

6. That said Voter’s ID card was not confiscated by the

authorities by any reason. Neither I violated any rules and
regulations;

7. That I am executing this affidavit to attest to the truth of the

foregoing facts and to request for a replacement of said ID
Card from Commission on Election.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

9th day of October 2019 at Roxas City, Philippines.

FORTUNATO M. BUTALON
Affiant
Pag-ibig MID No. 1580-0080-0192

SUBSCRIBED AND SWORN TO BEFORE ME, this 9 th day of October 2019 at

Roxas City Philippines.