REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, FEDERICO C. GAYONDATO, Filipino, of legal age, and a resident of
205 Kalihon Sinaliw Malaki, Alfonso Cavite, after being duly sworn in
accordance with law depose and state, that;
1. On April 10, 2017, while I was in Luksuhin Public Market, Luksuhin,
Alfonso Cavite I accidentally dropped my wallet;

2. Included inside my wallet is my Professional Driver’s License issued by

Land Transportation Office (LTO), ATM card issued by LandBank and
Senior Citizen Id;

3. Despite diligent efforts to recover the said wallet the same can no longer be
located;

4. I am executing this affidavit to attest to the truth of the foregoing facts and
not for any unlawful reasons.

IN TRUTH WHEREOF, I have hereunto affixed my signature this 10th day

of April, 2017 at Alfonso Cavite.

FEDERICO C. GAYONDATO
Affiant

SUBSCRIBE AND SWORN to before me this 10th day of April, 2017,

Affiant exhibiting to me his TIN Id card no. 207-775-287-000
WITNESS MY HAND AND SEAL.

Doc. No. 289 ;

Page No. 59 ;
Book No.XLVII;
Series of 2017.