REPUBLIC OF THE PHILIPPINES )

CITY OF QUEZON . . . . . . . . . . . . . . . ) S. S.

AFFIDAVIT

I, SALVADOR SORIANO, of legal age, single/married to ____________ and a resident

of __________________________________ after having been duly sworn on oath in accordance
with law hereby voluntarily depose and say:

` 1. That I am a driver by profession, with License No. __________ issued by the Board of
Transportation at __________________.

2. That sometime on May 11, 2012, Friday, I lost my wallet and cellular phone at No. 96
B ROTC Hunters, Delgado Compound, Barangay Tatalon, Quezon City. In that wallet I lost all
my ID’s: SSS ID, Company ID, Philhealth ID, two ATM Cards, Driver’s License and a stub in
COMELEC to get my ID.

3. That I took pains to look for said wallet and cellular phone but to no avail.

4. That I am executing this statement to attest to all the above facts, and to request the
proper authorities to grant me new ID’s and license.

IN TRUTH WHEREOF, I have hereunto signed my name below, this ____ day of
______ 2012 at _________________.

SALVADOR SORIANO
Affiant