Republic of the Philippines )

Baguio City ) SS.

AFFIDAVIT OF LOSS
I, DINO M. ULAT, of legal age, married, Filipino Citizen with residence and postal
address at #16 Sitio Katarasan, San Agustin Norte, Agoo, La Union, Philippines, after having
been duly sworn to in accordance with law do hereby, depose and say:

1. That I am a holder of the following items:

a) ATM/BPI CARD
b) NON-PROFESSNIONAL DRIVERS LICENSE
c) MEDICAL ID
d) SSS ID
e) PhilHealth ID
f) Cash

2. That in the evening of September 16, 2017 after our seminar I and my companions
went shopping at the Night Market, Harrison Road, Baguio City and thereafter went
to our billeting place at Pinsao Pilot, Baguio City and fell asleep. The following
morning, September 17, 2017, I woke up to check my Camelback black belt bag for
my personal belongings and discovered that my cellphone is inside it but my brown
leather wallet is missing. My said wallet contained the above-mentioned items. I
exerted diligent effort to locate my wallet but my effort proved futile, hence, lost
forever and beyond my recovery;

3. That the aforementioned ITEMS were never given nor pledged to anyone for any
purpose whatsoever, nor were taken or confiscated by the authorities for any violation
of the law; and

4. That I am executing this affidavit to attest to the veracity and truthfulness of my

foregoing statements and to replace the aforementioned items in lieu of the lost one
and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of September,
2017, at Baguio City, Philippines.

DINO M. ULAT
Affiant

SUBSCRIBED AND SWORN TO before me this 17th day of September, 2017 at

Baguio City, Philippines. Affiant personally appeared before me and represented to me himself
to be the same person who executed this instrument freely and willingly.

MODESTO T. ANDONG
Notary Public
Commission No. 35-NC-16-R/Until: December 31, 2017
PTR No. 2945281/01-05-2017/Baguio City
IBP No. 1056844/01-05-2017/Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
Doc. No. 274; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 055; BIR TIN No. 121-017-652
Book No. XXV; No. 19, 2nd Floor Old Market Bldg.,
Series of 2017. Magsaysay Ave., Baguio City, Philippines