Republic of the Philippines )

Province of Cavite ) S.S.

City of Trece Martires )

AFFIDAVIT OF LOSS

I, CHESTER GARCIA DELOS SANTOS, of legal age, Filipino citizen, single,

and a resident of Purok 6 Brgy. Conchu, Trece Martires City ,Cavite, after being
sworn in accordance with law hereby depose and say;

1. That I am a Person With Disability (PWD for brevity) [Speech

Impairment];

2. That as PWD I was issued of an Identification Card which was the details
I could no longer recall;

3. That on August 10, 2020, came to my attention that said PWD

Identification Card is no longer in my possession. With such loss, I could
only assume that my PWD Identification Card unknowingly fell when I
was on the vicinity of Manggahan Gen Trias City, Cavite;

4. That fervent efforts to retrieved the missing PWD Identification Card

proved ineffective as it is now declared loss for all legal purposes ;

5. That I am executing this affidavit to attest the truthfulness of the

foregoing declarations under penalties of perjury to respectfully
request the concerned office for the RE-ISSUANCE of a new PWD
Identification Card, moreover to further serve all legal intents and
purpose.

IN WITNESS WHEREOF, I have hereto affixed my signature on this 18 th day

of August 2020 at Trece Martires City, Cavite.

CHESTER GARCIA DELOS SANTOS

Affiant

  SUBSCRIBED AND SWORN to before me this 18 th day of August 2020 at Trece

Martires City Cavite. The affiant exhibited to me his Driver’s License bearing the
number D18-14-006854 as his competent proof of his identification and avowed
to me the foregoing facts and declarations.

Doc. No. : ______

Page No. : ______
Book No. : ______
Series of : 2020