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REPUBLIC OF THE PHILIPPINES )

Municipality of Bangued ) S.S.


Province of Abra )

AFFIDAVIT OF LOSS

I, VENESSA BIDALEN GARDO, Filipino, of legal age, and a


resident of Tiempo, Tubo, Abra, after having been duly sworn in
accordance with law, hereby depose and say:

1. That I am a holder of an ADTEMPCO Coop. Identification Card


issued by ADTEMPCO;

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

3. That sometime in December 2017, when I arrived home from


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

4. That diligent efforts to locate the same had proved futile;

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
ADTEMPCO Coop. ID card from ADTEMPCO.

IN WITNESS WHEREOF, I have hereunto affixed my signature


this 5 day of April 2018 at Bangued, Abra, Philippines.
th

VENESSA BIDALEN GARDO


Affiant

SUBSCRIBED AND SWORN TO before me, this 5th day of April


2018. The affiant, whom I identified through the following competent
evidence of identity: Unified Multi-Purpose ID CRN – 0001-
1479173-9, personally signed the foregoing instrument before me and
avowed under penalty of law to the whole truth of the contents of said
instrument.

Public Attorney I
PAO - Bangued, Abra
Roll No.
Pursuant to R.A. 9406