REPUBLIC OF THE PHILIPPINES)

CITY OF __________________ ) S.S

AFFIDAVIT OF LOSS OF FIREARM

I, XXXXXX, Filipino, of legal age, married, and with address at Brgy. xxxxxx.,
Tacloban City, Leyte after having been duly sworn to in accordance with law, hereby
depose and state:
1. I am the true and licensed owner of one (1) firearm, which is particularly
described as:

Model: Pistol Kind: Imb

Caliber: 45 Serial Number: xxxx

A copy of my Firearm License Card is hereto attached as Annex “A”;

2. On 08 November 2013, a super typhoon hit Tacloban City where I am currently

residing. Due to the nature of the typhoon, our house was washed-out, including
the above mentioned firearm;

3. Due to the nature of the incident and the lack of authorities at that time, I was not
able to report its loss within thirty (30) days pursuant to Firearm Law or RA
10591 or “Comprehensive Firearms and Ammunition Regulation Act”;

4. There was no memorandum or circular concerning the procedure of lost personal

firearms due to the super typhoon;

5. This affidavit is executed as a response to the notice of renewal issued by the

Philippine National Police Civil Security Group issued this 13 DECEMBER 2022;

6. That the above-mentioned firearm was indefinitely lost and that despite diligent
search and efforts, the same could no longer be found such that I now believe
that it is now lost beyond recovery;

7. I certify and confirm that the said firearm was neither confiscated nor relinquished
in favor of any government entity, agency, or authority, and;

8. This Affidavit is executed in order to attest to the truthfulness of the foregoing

narration of facts and for whatever legal purpose.

IN WITNESS WHEREOF, I have set my hand this 18th December 2022 at

___________________, Philippines.

  xxxxxxxxx
   Affiant 
 SUBSCRIBED AND SWORN to me, this _____________ at ___________,
Philippines by the Affiant whom I have identified through evidence of identity and who
exhibited his Driver’s License No. ____________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. ________
Book No. ________
Series of _________.
ANNEX “A”