Republic of the Philippines )

Taal, Batangas ) S.S.

AFFIDAVIT OF LOSS
I, CHARITY R. BAET, of legal age, Filipino, and resident of Brgy. Seiran, Taal,
Batangas, after being duly sworn according to law, hereby depose and state that:
1. On August 21, 2023, I lost my wallet which contained important identification
cards and loyalty cards at SM Lipa, Batangas.

2. Inside my lost wallet were the following:

a. Social Security ID No. 34-01266699;

b. PhilHealth ID No. 90502186204;
c. PAG-IBIG Loyalty Card;
d. Philippine National ID;
e. Citimart Value Card;
f. SM Advantage Card; and
g. BDO ATM card
3. I tried to find the said wallet which contained the abovementioned cards but I
cannot locate the same.

5. Despite diligent efforts exerted, the wallet along with the said items can no longer
be located, found or recovered, and to the best of our knowledge, they are truly lost.

6. The said identification cards and loyalty cards have not been confiscated by any
officer of the law or the issuing office or agency due to the violation of any law, statute, order,
rule or regulation.

7. I am executing this Affidavit to attest to the truth of the foregoing statements and
to request the issuance of new cards in lieu of the one which was lost.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, we have hereunto set my hand this ____________________

at Taal, Batangas.

CHARITY R. BAET
Affiant

SUBSCRIBED AND SWORN to before me this ______________________, affiant

exhibited to me her Competent Evidence of Identity by way of Driver’s License No. D18-17-
010176 expiring on 07/30/2027.

Doc. No. ______;

Page No. ______; ATTY. MA. ANGELICA J. GUMAPAC
Book No. ____; Notary Public
Series of 2023. Until December 31, 2024
Roll of Attorneys No. 69996
PTR No. 32128227/01.25.23/ Taal, Batangas
IBP No. 309564/02.03.23/Makati City
MCLE Compliance No. VII-0013254/ 03.24.22