REPUBLIC OF THE PHILIPPINES )

CITY OF LAS PIÑAS )

AFFIDAVIT OF LOSS

I, LUIS HURBODA REYES JR., of legal age, Filipino citizen,

married and a resident of #19 San Rafael III, Noveleta, Cavite,
Cavite, Cavite after having been duly sworn on oath in accordance
with law hereby voluntarily depose and say:

1. That I am the owner of the below listed firearm;

Kind / Make Caliber Serial Number

Pistol/COLT 45 2064855

2. That sometime in the month of August 2010 a very strong

typhoon hit our house which was situated beside the sea, said
typhoon wreck havoc on our house and almost all of our things have
been totally washed out, leaving only a small portion of our house
which have been left standing;

3. That I took pains to look for said firearm and other things
which was swept by flood, but to no avail;

4. That I am executing this statement to attest to the above

facts;

IN TRUTH WHEROF, I have hereunto signed my name below,

this 28th day of June, 2021 at Las Piñas City.

LUIS HURBODA REYES JR.

Affiant

SUBSCRIBED AND SWORN to before me, this 28 th day of June,

2021, by LUIS HURBODA REYES JR., who exhibited to me his
Unified Multi-Purpose ID CRN No. 006-0047-4655-5 issued at
Rosario, Cavite.

Doc. No
Page No.
Book No.
Series of 2021