REPUBLIC OF THE PHILIPPINES )
PROVINCE OF NUEVA VIZCAYA )S.S.
MUNICIPALITY OF BAMBANG)
AFFIDAVIT OF LOSS
(RE: RAFFLE TICKET)
I, DANIEL B. FABROS, JR., of legal age, married, Filipino, and a resident of
Nantawacan, Kasibu, Nueva Vizcaya, after having been duly sworn to in accordance
with law, do hereby depose and state:
1. That sometime in December 2020, I was given a Raffle Ticket with ticket No.
245653 upon payment of purchased product of Aldiz Incorporated for their
product promos;
2. That I kept said Raffle Ticket in my possession;
3. That however, just recently, when I am in need of said Raffle Ticket, I noticed
that the same is already missing;
4. That despite my earnest and diligent effort to locate said Raffle Ticket, it proved
futile and thus, said Raffle Ticket is now given up as lost;
5. That I attest to the veracity of the foregoing statements;
6. That I am executing this affidavit to attest that the said Raffle Ticket was lost
and for all legal intent and purposes that it may serve.
IN WITNESS WHEREOF, I hereby set my hand this 25 th day of March, 2021, at
Bambang, Nueva Vizcaya.
DANIEL B. FABROS, JR.
Affiant
CEI: DRIC. LIC. B15-20-001698
SUBSCRIBED and SWORN TO ME before this 25 th day March, 2021, at Bambang, Nueva
Vizcaya, affiant personally known to me to be the same person who executed the
foregoing affidavit.
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF NUEVA VIZCAYA )S.S.
MUNICIPALITY OF BAYOMBONG)
AFFIDAVIT OF LOSS
(RE: VACCINATION CARD)
I, DANIEL B. FABROS, JR., of legal age, married, Filipino, and a resident of
Nantawacan, Kasibu, Nueva Vizcaya, after having been duly sworn to in accordance
with law, do hereby depose and state:
1. That sometimes on October 21, 2021, I was issued a COVID-19 Vaccination Card
with ID No. 409-2D2 by the LGU of Bambang, Nueva Vizcaya;
2. That I kept said vaccination card in my possession;
3. That however, just recently, when I am in need of said vaccination card, I
noticed that the same is already missing;
4. That despite my earnest and diligent effort to locate said vaccination card, it
proved futile and thus, said vaccination card is now given up as lost;
5. That I attest to the veracity of the foregoing statements;
6. That I am executing this affidavit to attest that the said vaccination card was lost
and for all legal intent and purposes that it may serve.
IN WITNESS WHEREOF, I hereby set my hand this 12 th day of January, 2022, at
Bayombong, Nueva Vizcaya.
DANIEL B. FABROS, JR.
Affiant
CEI: DRIC. LIC. B15-20-001698
SUBSCRIBED and SWORN TO ME before this 12 th day January, 2022, at Bayombong,
Nueva Vizcaya, affiant personally known to me to be the same person who executed
the foregoing affidavit.
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF NUEVA VIZCAYA )S.S.
MUNICIPALITY OF BAMBANG)
AFFIDAVIT OF LOSS
(RE: DTI Certificate)
I, VENIRANDO T. DAWAN, of legal age, widower, Filipino, and a resident of
Purok 5, Barat, Bambang, Nueva Vizcaya, after having been duly sworn to in
accordance with law, do hereby depose and state:
1. That I am the owner of the business name DAWAN RICE MILL which is
registered with the Department of Trade and Industry (DTI) pursuant to the
provisions of Act 3883, as amended by Act 4147 and RA 863;
2. That sometimes on October 2021, I was issued a Certificate of Business Name
Registration which is valid from October 2021 until October 2026
3. That recently, when I was in need of it, I noticed that the same is already
missing;
4. That despite my earnest and diligent effort to locate said certificate, it proved
futile and thus, said certificate is now given up as lost;
5. That I attest to the veracity of the foregoing statements;
6. That I am executing this affidavit to attest that the said certificate was lost and
for all legal intent and purposes that it may serve.
IN WITNESS WHEREOF, I hereby set my hand this 14 th day of January, 2022, at
Bayombong, Nueva Vizcaya.
VENIRANDO T. DAWAN
Affiant
CEI: UMID CRN-0113-0049047-4
SUBSCRIBED and SWORN TO ME before this 14 th day January, 2022, at Bayombong,
Nueva Vizcaya, affiant personally known to me to be the same person who executed
the foregoing affidavit.
