REPUBLIC OF THE PHILIPPINES)

CALOOCAN CITY ) S.S.

AFFIDAVIT OF LOSS

I, ______, of legal age, Filipino and presently residing at ____, after having
duly sworn to in accordance with law, hereby depose and state:

1. That I was in possession of a PRC ID No.________;

2. That the said PRC ID was lost/missing;

3. That I cannot recall whether the said PRC ID was misplaced in our

house or I accidentally dropped outside our premises or places that I had

been;

4. That I diligently searched for the said missing PRC ID in our office and

even made inquiries with people who might have seen the said missing

PRC ID but all efforts proved futile as I can no longer locate the said

PRC ID and the same is now beyond recovery;

5. That I am executing this affidavit to attest to the truth of the foregoing

facts and for whatever it may serve best

AFFIANT SAYETH NAUGHT.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this 11 th day of May 2016 at

Caloocan City, Metro Manila. Affiant exhibited to me her ID No. ___.