Republic of the Philippines )

Zamboanga City ) S.S.

AFFIDAVIT OF LOSS
(re: Passbook)

KNOW ALL MEN BY THESE PRESENTS:

I, FELIX C. TANO, JR., of legal age, Filipino, single, and a residing at Bongao, Tawi-
Tawi, after having been sworn to in accordance with law, hereby depose and state the
following, that:

1. I am a Private First Class of the Philippine Navy stationed at the Headquarters

Marine Battalion Landing Team-12, Brgy. Nalil, Bongao, Tawi-Tawi;

2. I am a member of the Philippine Navy Savings and Loan Association, Inc. (PNSLAI)
for which I was issued a Green Passbook under the account number
_______________;

3. On March 26, 2021, a fire broke out in the battalion company headquarters burning
the barrack where I left the said Green Passbook;

4. Since the fire totally engulfed the barrack, it is now safe to conclude that recovery of
the said Green Passbook is impossible; and

5. Thus, I execute this Affidavit to attest to the truth of the foregoing, for the
replacement of Green Passbook, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this December 31,

2022 at Zamboanga City, Philippines.

FELIX C. TANO, JR.

Affiant
Competent Evidence of Identity: ____________________
Number: ____________

SUBSCRIBED and SWORN TO before me on the date and at the place indicated
below. The Affiant exhibited to me his competent evidence of identity as indicated
above.

Signed this December 31, 2022 at Zamboanga City, Philippines.

WITNESS MY HAND AND SEAL.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2022.