REPUBLIC OF THE PHILIPPINES )

CITY OF MUNITNLUPA ) S.S

AFFIDAVIT OF LOSS

I, ELEANOR J. ARCIAGA, of legal age, Filipino, married, and presently residing at B5

L28 Won St., Villa Carolina 1, Tunasan, Muntinlpa City, after having been duly sworn to in
accordance with law, do hereby depose and say: that-

1. That I am the holder of the following Original Official Receipts for Red
Ribbon, as follows to wit:

a. Official Receipt for S.N. 19A-0378572;

b. Official Receipt for S.N. 20A-0039559; and
c. Official Receipt for S.N. 20A-0033817
all issued by the Department of Foreign Affairs;

2. That the said Original Official Receipt(s) were misplaced/lost sometime on

January 2, 2020 at the vicinity of our office stated-above;

3. Despite diligent effort to locate the said Original Official Receipts, yielded negative
result;

4. That I execute this affidavit in order to attest the truth of the above facts for all
legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature

th
this 19 day of August, 2020, in the City of Muntinlupa, Philippines.

ELEANOR J. ARCIAGA
Affiant

SUBCRIBED AND SWORN to before me this 19th day of August, 20200,

in the City of Muntinlupa, Philippines, affiant having exhibited to me a current
Competent Identification with No. B-06145 issued by Office of the Senior Citizens
Affairs of City Gov’t of Muntinlupa, bearing a photograph and signature of the herein
affiant.
.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2020.