REPUBLIC OF THE PHILIPPINES)

TAGUIG CITY
).SS

AFFIDAVIT
I, ----, Filipino, of legal age, with address at ---after having been sworn to
in accordance with law, depose and state:
1.
2.
3.

I was issued a Voters ID by COMELEC.

While I was renting a room in Teachers Village, Quezon City, I lost
the bag containing said identification card. All efforts to recover the
card remain futile.
This affidavit is executed for whatever legal purpose it may serve.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this 3rd day of December

2013, affiant exhibited to me his______________ valid up to ___________
issued in _____________.
Doc. No. _____;
Page No._____;
Book No._____;
Series of 2013.