REPUBLIC OF THE PHILIPPINES )

CITY OF ANGELES ) S.S.

AFFIDAVIT OF LOSS

I, MA. ISABEL CALLEJA DAVID, of legal age, Filipino, single, and a resident of
Barangay Malabanias, Angeles City, after being sworn in accordance with law, depose and state
that:

1. I was issued Driver's license, Philippine passport, and Voter's ID by the Land
Transportation Authority, Department of Foreign Affairs, and the Commission
on Election, respectively;

2. Sometime in November of 2020, I was robbed. The robbers took my bag

where my Driver's license, Philippine passport, and Voter's ID are kept;

3. Diligent efforts were exerted to retrieve my bag but to no avail such that said
Driver's license, Philippine passport, and Voter's ID were beyond recovery;

4. I am executing this affidavit in order to attest to the truth of the foregoing

circumstances.

IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day of January 2021
in Angeles City.

MA. ISABEL CALLEJA DAVID

Affiant

SUBSCRIBED AND SWORN to before me in the City of Angeles this 12 th day of January 2021 by
Ma. Isabel Calleja David who is personally known to me and that she is the same person who
personally signed before me the foregoing and acknowledged that she executed the same
voluntarily.

Doc. No. ____;

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