Republic of the Philippines)

Province of Southern Leyte)s.s

Municipality of Tomas Oppus )
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AFFIDAVIT OF LOSS

I, ARRIAN MELCHOR BALABA, of legal age, Filipino and a resident of Brgy. Looc,
Tomas Oppus, Southern Leyte, after having been duly sworn to an oath in accordance with law,
hereby depose and say:

1. That I am a registered voter of Brgy. Looc, Tomas Oppus, Southern Leyte and such I
was issued a Voter’s ID by the Commission on Elections (COMELEC);

2. That the aforementioned Voter’s I.D. was placed inside my wallet;

3. That sometime December 2020, the aforementioned Voter’s ID got lost and nowhere
to be found;

4. That I exerted an exhaustive efforts to locate the same but my search proved futile as
I could not locate the same up to the present;

5. That I executed this affidavit in order to attest to the truth and veracity of the
foregoing so that I may be issued another one and for whatever legal intents and
purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________ in

the Municipality of Tomas Oppus, Southern Leyte, Philippines.

ARRIAN MELCHOR BALABA

Affiant
CRN:0111-4854944

SUBSCRIBED AND SWORN to before me this _________________ at Tomas Oppus,

Southern Leyte, Philippines