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CITY OF DAVAO
AFFIDAVIT OF LOSS
I, Christopher Santos, Filipino, of legal age, single and a resident of 055 Maginhawa St., Barangay 29-B,
Davao City, after having duly sworn to in accordance with law, hereby depose and say that:
IN WITNESS WHEREOF, I have hereunto set my hand this 29th of January in the City of Davao,
Philippines.
CHRISTOPHER S. SANTOS
Affiant
SUBSCRIBED AND SWORN to before me this _______________ in the City of __________, Philippines,
affiant having exhibited to me his/her community tax certificate with no. __________________ issued
on _________________ at ______________ .
Book No.________;
Series of 2018.