REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LAGUNA ) S.S.

AFFIDAVIT OF LOSS

I, JERICK DELA CRUZ ESTRELLA, single, of legal age, Filipino citizen, with
residence and postal address at Vanessa Homes, Brgy. Maytalang I, Lumban, Laguna,
after being duly sworn in accordance with law, hereby depose and state:

1. That I am the holder of a Social Security ID, Philhealth ID, BPI Atm Card,
BIR TIN ID and a Company ID issued by the PCN Promo Pros in
Mandaluyong City;

2. That I used to put said identification cards in my wallet inside my backpack;

3. That on July 22, 2017 at about 8:00 pm, as I was about to get off the bus
that I rode from work in Mandaluyong City to my home in Laguna, I noticed
that my said wallet was missing from my back pack;

4. That I suspect the said wallet to be stolen while I am fast asleep on the bus;

5. That upon searching, and despite diligent effort exerted, the said wallet
containing said ID’s is nowhere to be found and considered forever lost;

6. That this affidavit was executed to attest to the TRUTH of the foregoing
statements and to kindly request the concerned offices/agencies for any
respective actions or issuance of new ID in lieu of the aforementioned lost
identification cards and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 29th day of

July 2017 at Pagsanjan, Laguna.

JERICK DELA CRUZ ESTRELLA

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 29th day of July 2017 at

Pagsanjan, Laguna.

TORADIO R. ESPLANA
Notary Public
Until 31 December 2017
PTR No. 4503896 03 Jan 2017
Pagsanjan, Laguna
IBP No. 1001262 Roll No. 52577
MCLE Compliance No. V – 0021982
Issued on June 13, 2016
Doc No. : 78;
Page No. : 16;
Book No. : CXCIII;
Series of 2017.