REPUBLIC OF THE PHILIPPINES)

City of Lucena ) S. S.

AFFIDAVIT OF LOSS

I, RAYMON REY. P. SEVILLA, of legal age, Filipino, single, and a

resident of Sitio Zigzag, Barangay Batasan, San Jose, Occidental
Mindoro, after having been sworn to in accordance with law, do hereby
depose and state that:

1. I am a holder of a PAFCPIC Identification issued by

Philippine Army Finance Center Producers Integrated Cooperative;

2. The aforesaid identification was lost last August 2016 at the

above given address;

3. Earnest effort has been exerted by me to find the said

identification but to no avail; and

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

foregoing and for whatever legal purpose it may serve.

Affiant sayeth naught.

Lucena City, 3 March 2017.

RAYMON REY. P. SEVILLA

Affiant

SUBSCRIBED and SWORN to before me this 3rd day of March 2017

at Lucena City, affiant Raymon Rey P. Sevilla, appeared in person, was
identified by me through competent evidence of identity by exhibiting to
me his ID No._______________ bearing his photograph and signature
issued by Armed Forces of the Philippines, and signed the said Affidavit
of Loss in my presence.

Notary Public
Doc. No. ____
Page No.____
Book No. ___
Series of ____