Republic of the Philippines )

City of Cavite ) S.S.

x––––––––––x

AFFIDAVIT OF LOSS

I, Francisco M. Villanueva, Filipino, of legal age, married, and a resident of 129 Cpt.
Alberto Street, District of Caridad, Cavite City, Philippines, after being duly sworn in
accordance with law, depose and state that:

1. I am the true and licensed owner of a one (1) unit Cal 45 PISTL/ARMSCOR firearm
with Serial No. 452441PB.
2. Upon owning and registering the said firearm, I brought it to Cavite City where I reside.
3. On the night of September 25, 2009, I left the above-described firearm inside my
tricycle’s compartment. I had no problem leaving it there since I have done it on multiple
occasions.
4. On the next day, September 26, 2009, at around 9 in the morning, I noticed that the
compartment where I left my firearm was unlocked. I immediately checked if there was
something missing. Then and there I found that the above-described firearm was missing.
5. Despite diligent search and efforts to locate said firearm, I could not find the same such
that I now believe that it was stolen and is now lost beyond recovery.
6. As such, I am voluntarily executing this affidavit of loss to attest to the foregoing
circumstances and to further certify the authenticity and truthfulness of the foregoing
statements.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________

at the City of Cavite, Philippines.

FRANCISCO M. VILLANUEVA
Affiant

SUBSCRIBE AND SWORN to before me this _________ day of ____________, 2022,

at Cavite City, affiant exhibited to me his competent proof of identity as shown below his name.

Doc : __________
Page : __________
Book : __________
Series of : __________