REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI) S.S.

AFFIDAVIT OF LOSS

I, CACY JOY VELASCO OLVEGA, of legal age, Filipino citizen,

married, with residence address at 2607-E Bagong Diwa street, Poblacion,
Makati City, after having been duly sworn to in accordance with law, hereby
depose and state that:

I am a holder and possessor of the following items:

 Driver’s License
 LBP ATM card
 BDO Credit card
 Pag-Ibig Membership card

On or about 6:00 p.m. of 19 October 2021, I was waiting for a public

utility jeep along J.P. Rizal Street, in Poblacion, Makati City, when a culprit
riding a motorcycle snatched my bag containing the above-mentioned items;

The said culprit could not be located despite diligent effort; therefore,
considered the above-mentioned items lost for all intents and purposes;

I am executing this affidavit to attest to the truth of foregoing facts, for

information and guidance of the proper authorities concerned, for the
replacement of lost items and for whatever legal purpose this may serve.

Affiant sayeth naught.

 In witness whereof, I hereunto set my hand this 20th day of October
2021, in the City of Makati.

CACY JOY VELASCO OLVEGA

Affiant

SUBSCRIBED AND SWORN TO before me in the City of Makati, on

this 20th day of October 2021, affiant exhibiting before me her Taxpayer’s
Identification No. 222-507-892-000, issued by Bureau of Internal Revenue,
on September 25, 2019.

• (SGD.)
• Notary Public
• Until
• PTR No.
• Issued at on

Doc. No.
Page No.
Book No.
Series of 2021