REPUBLIC OF THE PHILIPPINES

( CITY OF ______ ) S.S.

AFFIDAVIT OF LOSS

I, ACAUILES C. LUSTRE, of legal age, single/married, Filipino, and a resident of B12

L16 PH1 Wellington Residence Brgy. Tres Cruses Tanza Cavite, after having been sworn
to in accordance with law hereby depose and say that:

1. I am a holder of NATIONAL ID under my name.

2. That sometime on February 05, 2024, the aforesaid object or card was lost along
the vicinity of SM CITY TANZA CAVITE together with my wallet.

3. That immediately after discovery of such loss or incident, I have exerted diligent
effort to recover the aforesaid document and it was considered lost for all
intents and purposes.

4. I execute this affidavit to attest to the truthfulness of the foregoing information,

and to secure the replacement of the said identification card as it was
mandatorily needed on my day to day living and for whatever legal purpose it
may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 08th day of

February 2024 in Makati City, Metro Manila, Philippines

ACAUILES C. LUSTRE
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of June 2024 in Makati
City, Metro Manila Philippines. Affiant exhibited to me his competent evidence of
identity as _______________ .

Doc No. _____ NOTARY PUBLIC

Page No. _____
Book No. ____
Series of 2024