REPUBLIC OF THE PHILIPPINES)

______________________________) Ss.
X - - - - - - - - - - - -- - - - - - - - - X

AFFIDAVIT OF LOSS FIREARMS

I,____________________________, of legal age, Filipino, and resident of ____________

after having been duly sworn to in accordance with law, do hereby depose and state the
following:
That I am the true and licensed owner of a one (1) unit _____________ firearm with Serial
No. _____________.
That on _____________, after having lunch at home, I was surprised to see our gate open
and when I went to close it, I discovered that my vehicle parked at our garage was also
opened;
I then discovered that my belt bag that I had left in the said vehicle was gone and with it are
the above-mentioned firearm, several rounds of ammunition, the original copy of my
License to carry the said firearm, some identification cards, and other important
documents;
That despite diligent search and efforts to locate said firearm, my belt bag and its
aforementioned contents, I could not find the same such that I now believe that all the
foregoing items were stolen and are now lost beyond recovery.
As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing.
IN WITNESS WHEREOF, I have hereunto affixed my signature this day of
_________________________ at _________________________, Philippines.

_________________________
Affiant
I.D. No. ____________________

SUBSCRIBED AND SWORN to before me this ______ day of ______________

hereat _________________________.

Doc. No.______;
Page No. ______; NOTARY PUBLIC
Book No.______;
Series of 2022.