REPUBLIC OF THE PHILIPPINES )

CITY OF QUEZON ) S.S.

AFFIDAVIT OF LOSS

I, Adrian P. Mangaoang, Filipino, of legal age, single and a resident of 14B

Ledesma Court, Culiat,
Tandang Sora, Quezon City, after having duly sworn to in accordance with law,
hereby depose and say
that:
1. I am a holder of a Certified Public Accountant Identification Card issued by
Professional Regulation
Commission;
2. I lost said Identification Card on May 10, 2011 and that I exerted all efforts
to locate the same but I
could not remember exactly where I placed it and it is considered lost for all
legal purposes;
3. Said Identification Card was not confiscated by any officer of the law by
reason of any violation of
any law, ordinance, presidential decree or rules and regulation of the said
Commission; and
neither was it offered as collateral for any loan;
I am executing this affidavit to attest to the foregoing facts;
IN WITNESS WHEREOF, I have hereunto set my hand this 13
th
of May in the City of Quezon, Philippines.

ADRIAN P. MANGAOANG
Affiant

SUBSCRIBED AND SWORN to before me this _______________ in the City of

__________, Philippines,
affiant having exhibited to me his/her community tax certificate with no.
__________________ issued
on _________________ at ______________ .
Doc. No. ________;
Page No. ________;
Book No.________;
Series of 2011.

REPUBLIC OF THE PHILIPPINES )

CITY OF QUEZON ) S.S.
AFFIDAVIT OF LOSS

I, Adrian P. Mangaoang, Filipino, of legal age, single and a resident of 14B

Ledesma Court, Culiat,
Tandang Sora, Quezon City, after having duly sworn to in accordance with law,
hereby depose and say
that:
1. I am a holder of a Certified Public Accountant Identification Card issued by
Professional Regulation
Commission;
2. I lost said Identification Card on May 10, 2011 and that I exerted all efforts
to locate the same but I
could not remember exactly where I placed it and it is considered lost for all
legal purposes;
3. Said Identification Card was not confiscated by any officer of the law by
reason of any violation of
any law, ordinance, presidential decree or rules and regulation of the said
Commission; and
neither was it offered as collateral for any loan;
I am executing this affidavit to attest to the foregoing facts;
IN WITNESS WHEREOF, I have hereunto set my hand this 13
th
of May in the City of Quezon, Philippines.

ADRIAN P. MANGAOANG
Affiant

SUBSCRIBED AND SWORN to before me this _______________ in the City of

__________, Philippines,
affiant having exhibited to me his/her community tax certificate with no.
__________________ issued
on _________________ at ______________ .
Doc. No. ________;
Page No. ________;
Book No.________;
Series of 2011.

REPUBLIC OF THE PHILIPPINES )

CITY OF QUEZON ) S.S.

AFFIDAVIT OF LOSS

I, Adrian P. Mangaoang, Filipino, of legal age, single and a resident of 14B

Ledesma Court, Culiat,
Tandang Sora, Quezon City, after having duly sworn to in accordance with law,
hereby depose and say
that:
1. I am a holder of a Certified Public Accountant Identification Card issued by
Professional Regulation
Commission;
2. I lost said Identification Card on May 10, 2011 and that I exerted all efforts
to locate the same but I
could not remember exactly where I placed it and it is considered lost for all
legal purposes;
3. Said Identification Card was not confiscated by any officer of the law by
reason of any violation of
any law, ordinance, presidential decree or rules and regulation of the said
Commission; and
neither was it offered as collateral for any loan;
I am executing this affidavit to attest to the foregoing facts;
IN WITNESS WHEREOF, I have hereunto set my hand this 13
th
of May in the City of Quezon, Philippines.

ADRIAN P. MANGAOANG
Affiant

SUBSCRIBED AND SWORN to before me this _______________ in the City of

__________, Philippines,
affiant having exhibited to me his/her community tax certificate with no.
__________________ issued
on _________________ at ______________ .
Doc. No. ________;
Page No. ________;
Book No.________;
Series of 2011.

REPUBLIC OF THE PHILIPPINES )

_______________) S.S.

AFFIDAVIT

I, ____________, Filipino, of legal age, single and a resident of

____________________________, after having duly sworn to in accordance
with law, hereby depose and say that:
 1. I am the common law wife/ live-in partner of deceased-member of
Pag-Ibig _________________;

2. That I and deceased ____________ have two children namely

__________ and ______________ and as such, I am the mother of the
said minors who have an interest in the Home Development Mutual
Fund (Pag-IBIG Fund Provident Benefits Claim/Insurance Claim of
the late _______________ payable by the Pag-IBIG Fund;

3. That the above-named minors are under my care and custody and I
am competent to receive in behalf of the said minors any amount due
to them;

4. I am executing this affidavit to attest to the foregoing facts for the

purpose of proving our relationship with deceased
_________________ and claiming the benefits under the Pag-ibig, and
for whatever legal purposes it may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this

______________ in the ______________, Philippines.
__________________
Affiant
SUBSCRIBED AND SWORN to before me this _____________ in the
_____________, Philippines, affiant having exhibited to me her
_______________.
Notary Public
Doc No.
Page No.
Book No. 1
Series of 2021