Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF LOSS
I, MARK ANTHONY ECHEVARRI y VICENTE, of legal age, Filipino citizen, single,
and a resident of Barangay Doclong 2 nd Camiling, Tarlac, after having been duly sworn to
in accordance with law, do hereby depose and stateTHAT:

1. In the morning of January 16, 2017, I placed my wallet in the pocket of my

pants and drove my motorcycle to Tarlac City, to buy motor parts;

2. My wallet contained the following, to wit;

a) Voters ID;
b) TIN Card ID;
c) PhilHealth Card;
d) Professional Drivers License;

3. After my transaction with the store, I decided to go home, and when I reached
the house I noticed that my wallet which I earlier kept in the pocket of my pants
was missing;

4. I carefully searched for my wallet in the other pockets of my pants but it was
not really there so, I went back along the road and asked the bystanders if they
have seen my wallet but they all answered in the negative, I also asked the
store owner if she has seen my wallet which might have been dropped in the
vicinity but also answered in the negative;

5. All my efforts to locate my wallet and the above-enumerated ID cards proved

futile; hence, I now consider them as lost and beyond recovery;

6. The above-mentioned ID cards were never pledged to secure any obligation,

and the incident was reported to San Clemente Police Station;

7. 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 1 st day of February,

2017 at Camiling, Tarlac, Philippines.

MARK ANTHONY V. ECHEVARRI

Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated above.
Affiant exhibited to me his employee ID with ID No. 00109676, Issued by Chowking,
Camiling Tarlac.

Doc. No. _______

Page No._______
Book No._______
Series of 2016