Republic of the Philippines

Camiling, Tarlac

)
) S.S.

AFFIDAVIT OF LOSS
I, CARY B. JAVIER, of legal age, Filipino citizen, single and a
resident of Barangay Pao 1st, Camiling, Tarlac, Philippines, under oath,
do hereby depose and state THAT:
1. I am a registered voter of Camiling, Tarlac, Philippines; thus, I
was issued a Voters Identification (ID) card which I usually
keep inside my wallet;
2. Lately, when I was organizing the contents of my wallet, I
discovered that my voter ID card was missing. I tried to look
for it in my other wallets but I found nothing. I also asked the
members of my household if they have seen the same but all
answered in the negative;
3. Diligent efforts exerted to locate my voter ID card proved
futile; hence, I now consider the same as lost and beyond
recovery;
4. I am executing this Affidavit to attest to the truth of the
foregoing statements and for all legal intents and purposes it
may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 4 th
day of November, 2016 at Camiling, Tarlac, Philippines.
CARY B. JAVIER
Affiant
SUBSCRIBED AND SWORN to before me on the date and place
indicated above. Affiant exhibited to me his Employee ID Card with
Number MSWD-34 issued by the Municipal Social Welfare and
Development, Camiling, Tarlac.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2016.