Republic of the Philippines)

City of Taguig, Metro Manila) S.S.

AFFIDAVIT OF LOSS

I, RECKY A. ELIMANGO, of legal age, Filipino Citizen, with residence

and postal address at Block 25, Lot 51, Purok 1, Upper Bicutan, Taguig 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. Professional Driver’s License Card and its corresponding Official

Receipt (O.R.), issued by the Land Transportation Office;
2. Voter’s Identification Card issued by COMELEC;

That sometime on October 2015, my wallet placed in my pocket,

containing the aforementioned items, and other important documents and
papers, was lost, probably said wallet fell from my pocket as I was walking on my
home;

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 23 rd day of

November 2016 at Taguig CIty, Metro Manila.

RECKY A. ELIMANGO
Affiant

SUBSCRIBED & SWORN TO BEFORE ME THIS 15th day of June 2016 at

Taguig City, Metro Manila, affiant exhibiting to me a copy of his Community Tax
Certificate No. CCI2016 00759977 issued at Taguig City on 11-15-16 and
Barangay Clearance issued by Barangay Upper Bicutan.

ATTY. VOLTAIRE BAN L. DELOS

REYES
Doc. No. 861. Notary Public
Page No. 171 . 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