REPUBLIC OF THE PHILIPPINES)

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

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AFFIDAVIT OF LOSS

I, MUNTASIL BANDAHALA, of legal age, Filipino, married and a resident of JJ

Drive, San Jose Gusu, Zamboanga City, after having been sworn to in accordance with law,
hereby depose and state:

1 That I am the holder of TIN 231-674-677 issued by the Bureau of Internal

Revenue of Zamboanga City;

2 That I usually place the said Identification card in my wallet, that sometime
on September 23, 2013, during the siege this city, we were told to
evacuate our residence at Tetuan, I discovered that said Identification card
was no longer in my wallet;

3 That I exerted diligent efforts to locate it but to no avail, hence, I hereby

consider them lost for all legal intents and purposes;

4 That I am executing this affidavit to attest to the veracity of the foregoing

statements and for the issuance of a new one in lieu of the loss.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature this
________________________________ at Zamboanga City, Philippines.

MAE FERCELYN Z. NATIVIDAD

Affiant

SUBSCRIBED AND SWORN to before me on the above-written date and place.

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