Republic of the Philippines

City of Tacloban

AFFIDAVIT OF LOSS

I, MARIO R. CABOTE, of legal age, married, Filipino, and currently a

resident of Brgy. Batiawan, Taft, Eastern Samar, after having been duly sworn
to in accordance with law, hereby depose and say, THAT:

1. I was a member of the Armed Forces of the Philippines (AFP)

with a rank of Master Sergeant and assigned at SOCOM PA;

2. On January 4, 2016 I retired from the said profession and I was

issued an identification (ID) card as such retiree;

3. However, when I looked for the said Retirement ID CARD the

same could not be found and must have been misplaced and
despite of diligent search and efforts, the same could no longer
be found such that I believe that it is now beyond recovery;

4. The said issued Retirement ID CARD was not confiscated for

any violation of laws, rules and regulations;

5. I am executing this Affidavit in order to attest the facts and

truthfulness of the foregoing statements, to substantiate my
claim that my Retirement ID CARD was indeed lost and to
support my application for the replacement/reissuance of the
same.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ at

the City of Tacloban, Philippines.

MARIO R. CABOTE
Affiant
VIN 3705-0014A-A2971MLR20000-3

SUBSCRIBED and SWORN TO BEFORE ME this ___________ at

Tacloban City, Philippines, affiant having personally known to me.

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Series of 2018