REPUBLIC OF THE 

PHILIPPINES )
Province of Zamboanga del Norte )
Dipolog City ) SS.

AFFIDAVIT OF LOSS

I, RAUL ICAO ELCAMEL, JR., Filipino, of legal age, single and a resident of Sto.
Tomas, Mutia, Zamboanga del Norte under oath hereby depose and state:

1. THAT I am a registered owner/holder of the following;

a. ATM Card issued by Metrobank;

b. ATM Card issued BPI-Dipolog City;
c. Professional Driver’s License with license No. JO1-18-001939 valid until
December 3, 2022, issued by the Honorable LTO-Dipolog City;

2. THAT sometimes on February 8,2021 somewhere in Sta. Isabel, Dipolog City,

I discovered that I lost my wallet containing the above-mentioned ATM Cards
and Professional Driver’s License;

3. THAT I exerted diligent efforts to locate the said wallet containing the above-
mentioned ATM Cards and Professional Driver’s License but to no avail and I
therefore considered the same as lost and can no longer be found/recovered;

4. THAT I am executing this Affidavit to attest to the truth of the foregoing facts
for the reissuance of the above-mentioned ATM Cards and Professional
Driver’s License and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 8 th day Of February,

2021 at Dipolog City, Zamboanga del Norte, Philippines.

RAUL ICAO ELCAMEL, JR.

Affiant
PDL : JO1-18-001939
Valid Until 12/03/2022

SUBSCRIBED AND SWORN to before me this 8 th day Of February,2021 at

Dipolog City, Zamboanga del Norte, Philippines, affiant exhibited to me his valid proof
of Identity as above-stated.

EARL RUSSELL S. PAULICAN

Notary Public
Until December 31, 2021
Roll No. 75530
PTR No. 2185126, 01/04/21, Dipolog City
TIN # 472-022-138
Notarial Commission No. SN: ZDN-DPL-042-2020

Doc No. ________;

Page No. _______ ;
Book No. _______;
Series of 2021.