REPUBLIC OF THE PHILIPPINES)

__________________________________) S.S.

AFFIDAVIT OF LOSS

I, ________________ of_____________, after being sworn in accordance with

law, hereby depose and state that –

1. I am the registered owner of a firearm, more particularly described

as follows:

MAKE:
KIND:
CALIBER:
SERIAL NO.: ________________

2. The above-described firearm was lost and could no longer be found

despite diligent search;

3. Finally, I am executing this affidavit to attest the truth and veracity

of the foregoing statements and for all legal intents and purposes it may serve.

4. Affiant sayeth naught.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 22 nd

day of March 2022 at __________

Affiant

SUBSCRIBED AND SWORN to before me, this 22 March, 2022 at, affiant exhibiting
to me his _________ as competent evidence of his identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2022.