REPUBLIC OF THE PHILIPPINES )

PROVINCE OF __________ ) SS.

AFFIDAVIT OF LOSS

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

after having been duly sworn in accordance with law, hereby depose and say:

1. That I was issued a Postal Identification Card;

2. That I placed said Identification Card in my wallet for safekeeping;

3. That on October 5, 2022, when I went to ______________, I inadvertently

dropped my wallet along the way. Despite diligent search and efforts to locate
said wallet, I could not find it. Hence, I deemed it lost and beyond recovery;

4. That I am executing this affidavit to request for the replacement of said

Identification Card;

5. Further, I am executing this affidavit to attest to the truth of the foregoing

and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 10th day of

October 2022 at ______________, Philippines.

___________________
Affiant

SUBSCRIBED AND SWORN TO before me, a notary public in and for Banaue,
Ifugao this 10th day of October 2022. The affiant personally signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of the
contents of said instrument.

Doc. No. ____;

Page
Doc.No.
No. ____;
___
Book
Page No.____;
No. ___;
Series of 2022.
Book No. ____
Series of 2022.