REPUBLIC OF THE PHILIPPINES)

City of Manila) S.S.

AFFIDAVIT OF LOSS

I, JEROME DAZA ROXAS, Filipino, of legal age, single, and a resident of 350 Dalisay St.
Bacood, Sta. Mesa Manila, after having been duly sworn in accordance with law, hereby depose and
say:
1. That I am the owner of a Postal I.D. issued by the Philippine Postal Corporation bearing
the name “Jerome D. Roxas”;
2. That I lost said Postal I.D. sometime in March 2020 and that I exerted all efforts to locate
the same but I could no longer find it and it is considered lost for all legal purposes;
3. That said Postal I.D. was not confiscated by any officer of the law by reason of any
violation of law, ordinance, or presidential decree and neither was it offered as collateral
for any loan;

4. That I am executing this affidavit to attest to the truth of the foregoing facts and to support
my application for a new Postal I.D. and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this____day of ____________

2020 at Manila, Philippines.

Jerome D. Roxas
Affiant

SUBSCRIBED AND SWORN TO before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that she voluntarily executed the
foregoing affidavit, read the same and understood its contents.

WITNESS MY HAND AND NOTARIAL SEAL

Doc. No. _____

Page No. _____
Book No. _____
Series of 2020.