Republic of 

the Philippines ) S.S.

City of Bacolod ) 

AFFIDAVIT OF LOSS

I, NATALIA M. JOQUINO, Filipino, of legal age, single, and a

resident of Barangay Singcang - Airport,  Bacolod City, Negros
Occidental, Philippines, after being duly sworn to in accordance with
law, hereby depose and state:

1. That I had in my possession my Employee’s Identification

Card denominated as 081094233, issued by the Provincial
Government of Negros Occidental;

2. That around May of 2021, while on board a Public Utility

Vehicle, my card holder containing the said Identification
card, must have inadvertently dropped from my purse;

3. That despite diligent search and efforts to locate the said

Identification Card, I could not find it and that I now believe
that it is lost beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest to the

truth of the foregoing and for the issuance of new UMID card.

IN WITNESS WHEREOF, I have hereunto set my hand this May

______, 2021 at Bacolod City, Philippines.

NATALIA M. JOQUINO
Affiant

SUBSCRIBED AND SWORN to before me, this May ___, 2021, by

NATALIA M. JOQUINO who exhibited to me her UMID Identification
Card (TIN) denominated as CRN 006-0062-8615-2, issued at Bacolod
City, Philippines.

Doc. No. ______;

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