REPUBLIC OF THE PHILIPPINES}

MUNICIPALITY OF PATEROS } S.S.

METRO MANILA }

AFFIDAVIT OF LOSS
I, ESMAEL K. ANDONGAN, of legal age, Filipino and resident of 170
Bantayan Ext., Palingon, Tipas, Taguig City, after having been duly sworn, does
hereby depose and say –

1. That I am a holder of the following personal properties, to wit:

a. Driver’s License
b. Ltopf
c. Firearm License
d. Permit to Carry
e. Philhealth ID
f. TIN ID
g. SSS ID
h. Pag-Ibig
i. Pawnticket
j. National ID of my wife – MERIAM A. ARSENIO
k. Motorcycle Key
l. GShock Watch
m. Money

2. That I am keeping the aforesaid personal Identification Cards and

personal belongings on our sling bag and place the same on a hook on
wall on our residence located at the above stated address.

3. However, when we woke up at about 6:30 in the morning on August 28,

2023, our bag was no longer on the place where we previously placed the
same, and upon reviewing the CCTV Cameras, we discovered that an
unidentified perpetrator took the same through the windows while we are
asleep.

4. I exerted diligent effort to locate my personal belongings above listed, but

proved futile; hence, I considered the same as beyond retrieve.

5. That the lost of my personal properties was beyond my control.

6. I am executing this Affidavit of Loss to attest the truth of the foregoing for
all legal purposes this may serve.

IN WITNESS WHEREOF, I affixed my signature this August 31, 2023 at

Pateros, Metro Manila.

ESMAEL K. ANDO
NGAN
Affiant

SUBSCRIBED AND SWORN to before me this August 31, 2023 at

Pateros, Metro Manila with Affiant affixing her signature in my presence and
within my notarial jurisdiction.

Doc. No. ____ ATTY. ROSENDO T. CAPCO

Notary Public for Taguig, Pateros and San Juan
Page No. ____ Commission expires on Dec. 31, 2024
Book No. ____ IBP No. 263890/1-3-23/Rizal
PTR 7308025/01-03-23/Pateros, MM.
Series of 2023 MCLE Compliance VII – 0020065
Attorney’s Roll No: 29311