REPUBLIC OF THE PHILIPPINES)

TAGUIG CITY ) S.S.

AFFIDAVIT OF LOSS
I, ARVIN VILLAMOR ANCAJAS, of legal age, single, Filipino, and a resident of Baang, Mobo,
Masbate, after having been sworn to in accordance with law hereby depose and say that:

1. I am a holder of a July 2022 Payslip issued by the CG Finance Service Unit.

2. Sometime in August 2022, I lost my wallet while traveling back at home .

3. All my valuable items, including the July 2022 payslip issued to me by CG Finance Service
were included.

4. I was not able to locate my wallet including my July 2022 payslip.

5. I execute this affidavit to attest to the truthfulness of the foregoing information, and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of August 2022 in
______________________________________.

ARVIN VILLAMOR ANCAJAS

Affiant

SUBSCRIBED AND SWORN to before me this _____ day of _______________ 2022 in

Taguig City, Philippines. Affiant exhibited to me his competent evidence of identity as
__________________.

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