Republic of the Philippines )

CITY OF SAN PEDRO S.S

Province of Laguna
x-------------------------------------------x

AFFIDAVIT OF LOSS and WILLINGNESS TO PAY

I, ROWENA G. PERDIGUERRA, of legal age, Filipino and with residential at 317

Magiting St. USPS San Antonio, City of San Pedro, Laguna, after having been duly sworn to in
accordance with law, hereby depose and say;

1. That, my late husband PO2 ARIEL N. PERDIGUERRA is a member of PNP with

Badge No. 043075:
2. That, as a member of the Philippine National Police he was issued Handcuff Smith &
Wesson with Serial No. 344783;
3. That, after he died I exerted all efforts to locate the said Hancuff but to no avail;
4. That, I am willing to pay the aforementioned Handcuff Smith & Wesson with Serial No.
344783;
5. That I am executing this affidavit in order to attest to the truth of the foregoing
statements, to inform the authorities concerned and for all legal intents and purposes this
may serve best;

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature

below, this 11th day of November, 2016 at the City of San Pedro, Laguna.

ROWENA G.
PERDIGUERRA
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of November, 2016 in City of
San Pedro, Laguna. Affiant having exhibited to me his/her proof of identity Voter’s I.D. with
No. 3425-0369A.

Doc. No: ________

Page No.:________
Book No.:________
Series of 2016