REPUBLIC OF THE PHILIPPINES )

CITY OF MUNITNLUPA ) S.S

AFFIDAVIT OF LOSS

I, MARK WENZ D. CAPARAS, of legal age, Filipino, single and presently residing at
0006 St. James St. Promise Land Compd. Magdaong Drive NBP Res. Poblacion, Muntinlupa
City, after having been duly sworn to in accordance with law, do hereby depose and say: that-

1. That I am the holder of a Official Receipt issued by NATIONAL BUREAU

OF INVESTAGATION (NBI) ;

2. That the said Official Receipt was misplaced/lost sometime on December 25,
2020 in the vicinity of my home address stated-above;

3. Despite diligent effort to locate the said Official Receipt, 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 29 day of June, 2021, in the City of Muntinlupa, Philippines.

MARK WENZ D. CAPARAS

Affiant

SUBCRIBED AND SWORN to before me this 29th day of June, 2021, in

the City of Muntinlupa, Philippines, affiant having exhibited to me a current Competent
Identification with No.N26-20-00693 issued by LTO, bearing a photograph and signature
of the herein affiant.
.

Doc. No. _________;

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