Republic of the Philippines)

City of Taguig ) S.S.

AFFIDAVIT OF LOSS

I, MARIE FLOR RIBOT GALLETA, of legal age, Filipino Citizen, with

residence and postal address at #87 Sitio GSIS, San Martin De Porres,
Parañaque City, after having duly sworn to in accordance with law do hereby
depose and state:

That I am an owner and holder of the following items:

1. ATM Card issued by Metrobank;

2. SSS Digitized ID Card issued by the Social Security;
3. Voter’s Identication Card, issued by COMELEC;
4. Health Card, issued by Intellicare;
5. PhilHealth ID issued by the Philippine Health Insurance Corporation;
6. Pag-ibig Membership ID issued Pag-IBIG(Home Dev’t Mutual Fund);
7. TIN ID Card issued by Bureau of Internal Revenue;
8. Barangay ID issued by San Martin De Porres, Parañaque City;
9. Ninong Ko Si Max Card issued by Max’s Restaurant;

That on May 14, 2016, at around 11 o’clock in the evening, my wallet

placed in my bag, containing the aforementioned items, and other important
documents and papers, was lost, probably said wallet fell from my bag as I was
riding a TAXI from Market Market, Taguig City going to my residence;

That I exerted all efforts to locate or find the aforementioned items, but
proved futile and meaningless whatsoever;

That I am executing this AFFIDAVIT to attest to the truth and veracity of

the above statements for all LEGAL INTENTS and PURPOSES it may serve
best.

IN WITNESS HEREOF, I have hereunto signed my name this 16 th day of

May 2016 at Taguig CIty, Metro Manila.

MARIE FLOR RIBOT GALLETA

Affiant

SUBSCRIBED & SWORN TO BEFORE ME THIS 16th day of May 2016 at

Taguig City, Metro Manila, affiant exhibiting to me her Company ID bearing
TIN:241-017-168.

ATTY. VOLTAIRE BAN L. DELOS

REYES
Doc. No. 315 . Notary Public
Page No. 64 . Cities of Taguig, Pasig, San Juan and Pateros
Book No. VI . Commission Appointment No. 80(2015-2016)
Series of 2016. Until December 31, 2016/ MCLE NO. IV-0018532
IBP Lifetime Member No. 013905; Cavite / Roll No.
61669
PTR No. A-2601004;1-05-2016; Taguig City
B25 L39, Upper Bicutan, Taguig City