Republic of the Philippines )

City of Ormoc ) S.S.

AFFIDAVIT OF LOSS

I, ANTONIO P. NABRE, of legal age, Filipino, single and with residence at

Poblacion, Albuera, Leyte, after having been sworn to oath in accordance with
law, hereby depose and state:

1. That I am a holder of a voters identification card issued by

Commission of Elections (COMELEC);

2. That I used to put said identification card inside my wallet;

3. That sometime on April 2015, when I arrived home from

work, I discovered that my voters ID card was no longer in
my wallet where I used to place it;

4. That efforts were exerted to locate said ID card, but in spite of

diligent search, it could not be found and the same is now
beyond recovery;

5. That said ID card was not confiscated by the authorities or

used in violation of the law;

6. That I am executing this affidavit to attest to the truth of the

foregoing facts and to request for a replacement of said
Voters ID card from COMELEC.

IN WITNESS WHEREOF, I have hereunto affixed my signature this __ day

of March 2017 at Ormoc City, Leyte.

ANTONIO P. NABRE
Affiant

Subscribed and sworn to before me this 30th day of March 2017 at

Ormoc City, Leyte. Affiant exhibiting to me his Taxpayer Identification Number
____________________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.