REPUBLIC OF THE PHILIPPINES )

City of Roxas ) S.S.

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

AFFIDAVIT OF LOSS

I, AILEEN B. ABELLANO, Filipino, of legal age, married and

a resident of Brgy. Angub, Cuartero, Capiz, after having been
duly sworn in accordance with law, hereby depose and state:

1. That I am a holder of a UMID I.D, duly issued by the

GSIS;

2. That the said UMID I.D and its whereabouts could not
be ascertained;

3. That diligent efforts to locate and search in places

where I have been on that day, I lost it; However,
said UMID I.D was nowhere to be found;

4. That said UMID Identification Card was not

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

5. That I am executing this affidavit to attest to the

truth of the foregoing facts and to request for a
replacement of said UMID I.D.

IN WITNESS WHEREOF, I have hereunto set my hand

this 6th day of March, 2020 at the Roxas City, Philippines.

AILEEN B. ABELLANO
PRC I.D No.
0452699

SUBSCRIBED AND SWORN to before me this 6th day

of March, 2020 in the City of Roxas, Philippines. I further
CERTIFY that I have personally examined the affiant, and I
am fully satisfied that she voluntarily executed the foregoing
Affidavit, and she read and understood the contents thereof.