REPUBLIC OF THE PHILIPPINES)

CITY OF ZAMBOANGA. . . . . . . )S.S.

AFFIDAVIT OF LOSS
I, IRENE E. TOLENTINO, of legal age, Filipino, married and a
resident of Tumaga Interior, Zamboanga City, after having been sworn to in
accordance with law, hereby depose and state:
1. That I am the holder of the following Identification cards:
a. Non-Professional Drivers License
b. SSS ID
c. LB Suki Card
which were kept inside my wallet;
2. That on May 18, 2015 at around 12 noontime, said IDs
accidentally fell out from my pocket while I was riding on a
motorcycle from Doctors Hospital bound for the city proper;
3. That I tried to locate it but could no longer be found and the
same is hereby considered lost; and
4. That I am executing this affidavit to attest the truthfulness of
the foregoing statement and for whatever legal purposes
this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my
signature this 18th day of May, 2015 at Zamboanga City, Philippines.
IRENE E. TOLENTINO
Affiant
SUBSCRIBED AND SWORN to before me on the above date and
place.