REPUBLIC OF THE PHILIPPINES)

C I T Y O F M A K A T I ) S.S.

AFFIDAVIT OF LOSS

I, FERNANDO RETOMA ROSENTO, of legal age, Filipino citizen, with residence

address at 7904 D. Villar Street, Barangay Pio Del Pilar, Makati City, Philippines, after
having duly sworn to in accordance with the law do hereby depose and state that:

I am a holder and in possession of Makatizen Card issued by City Government of

Maakati;

Discovery in the loss of aforesaid item has been established due to circumstance
beyond knowledge; whereof, assuming that the same misplaced and could no longer be
found;

Diligent effort has been made but futile; therefore considered it lost for all intents
and purposes;

I am executing this affidavit to attest to the truth of foregoing facts, for information
and guidance of proper authorities concern and for whatever legal purpose this affidavit
may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto set my hand on this 07 th day of June 2021, in the
City of Makati.

FERNANDO RETOMA ROSENTO

Affiant

SUBSCRIBED AND SWORN to before me on this 07th day of June 2021, in the City of
Makati.

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SERIES OF: 2021