Republic of the Philippines

City of Iloilo ) S.S.

AFFIDAVIT OF LOSS

I, IRAYA, MA. FE CABEZAS, of legal age, Filipino, widow and a

resident of Poblacion Ilaya, Sara, Iloilo, after having been duly sworn to in
accordance with law, hereby depose and say:

1. That I am the owner of a Hongkong ID;

2. That the said Hongkong ID was last seen in my document
envelope;
3. That the said Hongkong ID was last seen by me last December
18, 2012;
4. That the said Hongkong ID was lost for all intents and purposes
and cannot be located despite all efforts exerted to locate the
same due to Super Typhoon Yolanda (Haiyan);
5. That I am executing this affidavit to attest to the truth to all the
above facts.

IN WITNESS HEREOF, I have hereunto signed my name below this

7th day of February, 2020 at Iloilo City, Philippines.

MA. FE C. IRAYA
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 29th November,

2020, affiant exhibited to me her Passport ID with ID No. P43105878 with
date of issuance last 1/7/2020.
Doc No. __
Page No. __
Book No. __
Series of 2020