REPUBLIC OF THE PHILIPPINES)

PROVINCE OF NUEVA ECIJA )

CITY OF CABANATUAN )S.S.
X---------------------------X

AFFIDAVIT OF LOSS

I, RUFINO M. PAGLINAWAN of legal age, Filipino, married and a

resident of 147 Gen. Tinio Ext., Cabanatuan City, after having been duly sworn to
in accordance with law hereby depose and say:

1. That I am depositor of PBCOM Bank, Maharlika Hi-way, Cabanatuan

City;

2. That the said bank issue me a Certificate of Time Deposit No. 00201
and in my possession said Certificate of Time Deposit was loss;

3. That despite diligent search to locate the said Certificate of Time

Deposit same could no longer be located elsewhere;

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

facts for whatever legal intents it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day

of ______ 2019, here at Cabanatuan City.

RUFINO M. PAGLINAWAN
Affiant

SUBSCRIBED AND SWORN to before me this____ day of ______

2019, here at Cabanatuan City.

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF NUEVA ECIJA )
CITY OF CABANATUAN )S.S.
X---------------------------X

AFFIDAVIT OF LOSS

I, KATHERINE V. PRIMICIAS of legal age, single, Filipino and a

resident of # 245 Purok 6, Brgy. Murcon, Llanera, Nueva Ecija, after having been
duly sworn to in accordance with law hereby depose and say:

1. That I am a lawful holder of Taxpayer Identification Number

ID (TIN ID);

2. That the said TIN ID was lost/misplaced unwittingly in my

possession;

3. That despite diligent search to locate the said TIN 5ID same
could no longer be located elsewhere;

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

foregoing facts for whatever legal intents it may serve and
hereby requesting for the replacement of the said lost item.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of

December 2018, here at Cabanatuan City.

KATHERINE V. PRIMICIAS
Affiant

SUBSCRIBED AND SWORN to before me this 7 th day of December

2018, here at Cabanatuan City.

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2018
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF NUEVA ECIJA )
CITY OF CABANATUAN )S.S.
X---------------------------X

AFFIDAVIT OF LOSS

I, CHONA C. QUERIJERO-AURO of legal age, Filipino, married and

a resident of Brgy. Bonifacio Ext. Baler, Aurora, after having been duly sworn to
in accordance with law hereby depose and say:

1. That I am a bona fide member of Social Security System with SSS No.
33-5516645-0 and a lawful holder of SSS ID;

2. That the said SSS ID was lost/misplaced unwittingly in my possession;

3. That despite diligent search to locate the said SSS ID same could no
longer be located hence it was deemed lost;

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

and to report this matter to the authorities because maybe it can be used
to any illegal act and hereby request for the replacement of the said lost
item.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of

_______________ 2018, here at Cabanatuan City.

CHONA C. QUERIJERO-AURO
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of

_____________ 2018, here at Cabanatuan City.

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2018.