Republic of the Philippines)

DONE: CITY OF BAGUIO…..) SS.

AFFIDAVIT OF LOSS
I, FAITH SEGUNDO SAINGAN, single, of legal age, Filipino Citizen, with residence
and postal address at 93 Km. 7, Asin Road, Tadiangan, Tuba, Benguet, Philippines, after having
been duly sworn to in accordance with law do hereby deposes and states, that:

1. I am a holder of a Unified Multi-purpose Identification Card bearing UMID

Number CRN-0111-9815199-6 for being a member of the Social Security System
(SSS) under SS No. 01-2689148-1;

2. I kept my aforesaid ID in my bag and used it only everytime proof of my identity is

needed. Sometime last month, April, 2023, I was about to transact with a certain
office, however, when I checked for my UMID ID Card, I could no longer locate it. I
am not sure how I lost it, maybe I accidentally misplaced it;

3. I exerted diligent efforts to locate my UMID ID Card but to no avail, hence,

considered forever lost;

4. The said UMID ID Card has not been given nor pledged to anyone for any purpose
whatsoever, nor was it taken nor confiscated by the authorities for any violation of
traffic rules and regulations and for any law;

5. I am executing this affidavit to attest to the truth of my foregoing statements and to

secure new UMID ID Card 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 13th day of May, 2023, at
Baguio City, Philippines.

FAITH SEGUNDO SAINGAN

AFFIANT
Passport No. P4546244B
Issued On: January 25, 2020
Valid Until: January 24, 2030

SUBSCRIBED AND SWORN TO before me this 13th day of May, 2023, at Baguio City,
Philippines. Affiant personally appeared and to be the same person who executed this instrument
as her free act and deed.

Doc. No. ____________;
Page No. ____________;
Book No. 65;
Series of 2023.
MODESTO T. ANDONG
Notary Public
Comm. N.A.-56-NC-22-R until Dec. 31, 2024
PTR No. 4902764/1-04-2023
IBP OR No. 271717/1-5-2023
ROLL No. 31289/5-15-81/Manila
BIR TIN No. 121-017-652-000
MCLE Comp. No. VII-0025907/Valid Until: April 14, 2025
ANDONG and NEBATEN LAW OFFICE
No. 19 2nd flr., Old Market Building,
Upper Magsaysay Ave., Baguio City, 2600