REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S.S.

AFFIDAVIT OF LOSS
I, ________________________________, Filipino, of legal age,
______________________ and with office address at _____________________, Quezon
City, Metro Manila, after having been duly sworn in accordance with law, hereby
certify that:

1. I am an ____________________________ with office address as

stated above.

2. On ___________________________,
______________________________________________________ but despite
diligent efforts exerted, my I.D. cannot be located. Thus, I have considered the
said I.D. lost for all intents and purposes.

3. I am executing this Affidavit of Loss to attest to the truth of the

foregoing and for the purpose of securing and registering a replacement I.D.
and for whatever legal purposes this Affidavit of Loss may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have set my hand on these presents this

________________ in Quezon City, Metro Manila.

_________________________________
Affiant

SUBSCRIBED AND SWORN to before me this _________________________

at Quezon City, Metro Manila, Affiant exhibiting to me as competent evidence of
identity her _________with number _______________.

Doc No. ;
Page No. ;
Book No. ;
Series of 2023.