You are on page 1of 2

REPUBLIC OF THE PHILIPPINES)

IN THE CITY OF ILOILO ) s.s


x--------------------------------------------x

AFFIDAVIT OF LOSS

I, DORWIN JOHN ASESOR DIESTO, of legal age, single,


Filipino and with address at St. Elizabeth Restaurant Brgy.,
Ermita Coastal Road, Dumangas, Iloilo, Philippines, after
having been duly sworn to in accordance with law, hereby
depose and state:

1. That I am the owner/ holder of PRC ID with License ID


No: 0628718;

2. That sometime in 2016, when I was in Manila about to


board the ship of P&O cruises where I worked as their bar
staff, I discovered that my PRC ID is missing from my
wallet where I usually kept the same.

3. That despite serious efforts to locate the said license, it


cannot be found and is considered lost;

4. That I lost all hope in finding such identification card,


hence, I execute this Affidavit to establish the fact of loss so
that I can ask a re- issuance from PRC of the said ID with
the same details and information and for whatever legal
purpose it may serve.

IN WITNESS WHEREOF, I hereby affixed my signature


this _______________ at Iloilo City, Philippines.

DORWIN JOHN ASESOR DIESTO


Birth Certificate Local Registry No. 87-11428
(Affiant)

SUBSCRIBED AND SWORN to before me this


________________ at Iloilo City, Philippines. Affiants exhibited
to me his valid proof of identity as shown below his name and
signature.

Doc. No. __________;


Page No. __________;
Book No. __________;
Series of 2022.

You might also like