You are on page 1of 9

Republic of the Philippines )

City Of Santiago ) SS

AFFIDAVIT OF LOSS

I, Lucky Joy A. Domingo., of legal age, Filipino, single, and a resident of Cabulay, Santiago
City, after having duly sworn in accordance to law, hereby depose and state:
1. That I am the owner and holder of the following: a) Taxpayer’s Identification Card
issued by BIR; and B) PHILHEALTH CARD;

2. That I have always kept the said cards in my wallet which I always bring every
time I go out;

3. That my wallet and its contents including the abovementioned cards were
unfortunately lost sometime in November 24, 2014 at about 11:00 o’ clock in the
morning inside the office where I am working;

4. That I have exerted diligent efforts to locate my wallet including its contents but in
vain; hence, the same are now considered lost beyond recovery;

5. That I am executing this affidavit to attest to the truth of the foregoing and to
support of my application for the replacement of my lost a) Professional
Identification Card (PRC); b) Taxpayer’s Identification Card; and c) PHILHEALTH
Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 24 th day of


November, 2014 at Santiago City.

affiant
PRC ID No. 0350753

SUBSCRIBED AND SWORN to before me this 24 th day of November, 2014 at


Santiago City.

WITNESS MY HAND AND SEAL.

Doc. No. 280; ATTY. ABRAHAM B. SABLE


Page No. 56; NOTARY PUBLIC
Book No. 101; PTR No.0442385,01-11-10
Series of 2010. Until December 31,2011
Santiago City
Republic of the Philippines )
City of Santiago )SS

AFFIDAVIT OF LOSS

I, NENITA A. ABARA., of legal age, Filipino, married, and a resident of Masaya


Centro, San Agustin, Isabela, after having been duly sworn in accordance with law,
hereby depose and state:

6. That I am the owner and holder of the following: a) Professional Identification


Card for Teachers issued by Professional Regulatory Commission with I.D. No.
0350753; b) Taxpayer’s Identification Card issued by BIR; and c) PHILHEALTH
CARD;

7. That I have always kept the said cards in my wallet which I always bring
everytime I go out;

8. That my wallet and its contents including the abovementioned cards were
unfortunately lost sometime in October 22, 2010 at about 11:00 o’ clock in the
morning inside my classroom where I am teaching;

9. That I have exerted diligent efforts to locate my wallet including its contents but in
vain; hence, the same are now considered lost beyond recovery;

10. That I am executing this affidavit to attest to the truth of the foregoing and to
support of my application for the replacement of my lost a) Professional
Identification Card (PRC); b) Taxpayer’s Identification Card; and c) PHILHEALTH
Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 27 th day of October,


2010 at Santiago City.

NENITA A. ABARA
affiant
PRC ID No. 0350753

SUBSCRIBED AND SWORN to before me this 27th day of October, 2010 at


Santiago City.

WITNESS MY HAND AND SEAL.

Doc. No. 280; ATTY. ABRAHAM B. SABLE


Page No. 56; NOTARY PUBLIC
Book No. 101; PTR No.0442385,01-11-10
Series of 2010. Until December 31,2011
Santiago City
Republic of the Philippines )
City of Santiago )SS

AFFIDAVIT OF LOSS

I, MARILYN B. JAVIER, of legal age, Filipino, married, and a resident of 133,


Purok 2, Salvador, Santiago City, after having been duly sworn in accordance with law,
hereby depose and state:

11. That I am the holder of Social Security System Identification Card and Social
Security System Identification Card of my sister, HILDA BAUTISTA;

12. That I have always kept the said cards in my wallet which I always bring
everytime I go out;

13. That my wallet and its contents including the abovementioned cards were
unfortunately lost;

14. That I have exerted diligent efforts to locate my wallet including its contents but in
vain; hence, the same are now considered lost beyond recovery;

15. That I am executing this affidavit to attest to the truth of the foregoing and to
support of my application for the replacement of my lost Social Security System
Identification Card and Social Security System Identification Card of my sister,
HILDA BAUTISTA.

IN WITNESS WHEREOF, I have hereunto set my hand this 13 th day of April,


2010 at Santiago City.

MARILYN B. JAVIER
affiant
DepEd I.D. No. 0021999

SUBSCRIBED AND SWORN to before me this 13th day of April, 2010 at Santiago
City, Philippines.

WITNESS MY HAND AND SEAL.

Doc. No. 337; ATTY. ABRAHAM B. SABLE


Page No. 69; NOTARY PUBLIC
Book No. 93; PTR No.0442385,01-11-10
Series of 2010. Until December 31,2011
Santiago City
Republic of the Philippines )
City of Santiago )SS

AFFIDAVIT OF LOSS

I, GILBERT A. ODULIO, SR., of legal age, Filipino, married, and a resident of 15


Perez St., Calao West, Santiago City, after having been duly sworn in accordance with
law, hereby depose and state:

16. That I am the owner and holder of the following: a) PHILHEALTH Card with I.D.
No. 06-025020052-0 b) Firearm License; c) Permit to Carry Firearm License d)
Professional Driver’s License with No. N04-90-163886; e) Tax Identification No.
901-159-493; f) Social Security System I.D. No. 3303071597; and g) KABAYAN
ACTION GROUP I.D. No. 023638;

17. That I have always kept the said cards in my wallet which I always bring
everytime I go out;

18. That my wallet and its contents including the abovementioned cards were
unfortunately lost sometime in February 18,2010 at about 9:00 to 11:00 o’ clock
in the morning along Victory Norte, Victory Sur or Patul Road;

19. That I have exerted diligent efforts to locate my wallet including its contents but in
vain; hence, the same are now considered lost beyond recovery;

20. That I am executing this affidavit to attest to the truth of the foregoing and to
support of my application for the replacement of my lost a) PHILHEALTH Card
with I.D. No. 06-025020052-0 b) Firearm License; c) Permit to Carry Firearm
License d) Professional Driver’s License with No. N04-90-163886; e) Tax
Identification No. 901-159-493; f) Social Security System I.D. No. 3303071597;
g) KABAYAN ACTION GROUP I.D. No. 023638.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of February,
2010 at Santiago City.

GILBERT A. ODULIO, SR.


affiant
TIN 901-159-493

SUBSCRIBED AND SWORN to before me this 20th day of February, 2010 at


Santiago City, Philippines.

WITNESS MY HAND AND SEAL.

Doc. No. 232; ATTY. ABRAHAM B. SABLE


Page No. 48; NOTARY PUBLIC
Book No. 91; PTR No.0442385,01-11-10
Series of 2010. Until December 31,2011
Santiago City
Republic of the Philippines )
City of Santiago )SS

AFFIDAVIT OF LOSS

I, POE D. RUMBAWA, SR., of legal age, Filipino, married, and a resident of


Rizal, Santiago City, after having been duly sworn in accordance with law, hereby
depose and state:

21. That I am the owner and holder of the following: a) PHILHEALTH Card issued by
Philhealth Santiago City Branch, Santiago City; b) Barangay Intelligence Network
(BIN) Identification Card issued by Philippine National Police-Region 2; c)
Guardian’s Identification Card; d) Professional Driver’s License issued by LTO-
Santiago City;

22. That I have always kept the said cards in my wallet which I always bring
everytime I go out;

23. That my wallet and its contents including the abovementioned cards were
unfortunately lost sometime in January 22, 2010 at about 5:00 o’ clock in the
afternoon;

24. That I have exerted diligent efforts to locate my wallet including its contents but in
vain; hence, the same are now considered lost beyond recovery;

25. That I am executing this affidavit to attest to the truth of the foregoing and to
support of my application for the replacement of my lost a) PHILHEALTH Card
issued by Philhealth Santiago City Branch, Santiago City; b) Barangay
Intelligence Network (BIN) Identification Card issued by Philippine National
Police-Region 2; c) Guardian’s Identification Card; d) Professional Driver’s
License issued by LTO-Santiago City.

IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of January,


2010 at Santiago City.

POE D. RUMBAWA, SR.


affiant

SUBSCRIBED AND SWORN to before me this 29 th day of January, 2010 at


Santiago City, Philippines.

WITNESS MY HAND AND SEAL.

Doc. No. 71; ATTY. ABRAHAM B. SABLE


Page No. 17; NOTARY PUBLIC
Book No. 90; PTR No.0442385,01-11-10
Series of 2010. Until December 31,2011
Santiago City
Republic of the Philippines )
City of Santiago )SS

AFFIDAVIT OF LOSS

I, MANUEL R. OIDEM, of legal age, Filipino, married, and a resident of 268 San
Jose St., Cabugao, Echague, Isabela, after having been duly sworn in accordance with
law, hereby depose and state:

26. That I am the owner and holder of the following: a) Professional Regulatory
Commission Identification Card issued by PRC Manila; b) ATM CARD issued by
Philippine National Bank (PNB); c) Company Identification Card issued by
Senator Crewing Manila; d) Residential Certificate issued by Manila; e)
Professional Driver’s License issued by LTO-Manila and f) Family Picture;

27. That I have always kept the said cards in my wallet which I always bring
everytime I go out;

28. That my wallet and its contents including the abovementioned cards were
unfortunately lost sometime in January 9, 2010 at about 1:00 o’ clock in the
afternoon at the tricycle from Echague going to Santiago City;

29. That I have exerted diligent efforts to locate my wallet including its contents but in
vain; hence, the same are now considered lost beyond recovery;

30. That I am executing this affidavit to attest to the truth of the foregoing and to
support of my application for the replacement of my lost Professional Regulatory
Commission Identification Card , ATM CARD issued by Philippine National Bank
(PNB), Company Identification Card issued by Senator Crewing Manila,
Residential Certificate issued by Manila, and Professional Driver’s License
issued by LTO-Manila.

IN WITNESS WHEREOF, I have hereunto set my hand this 11 th day of


December, 2010 at Santiago City.

MANUEL R. OIDEM
affiant

SUBSCRIBED AND SWORN to before me this 11 th day of January, 2010 at


Santiago City, Philippines.

WITNESS MY HAND AND SEAL.

Doc. No. 43; ATTY. ABRAHAM B. SABLE


Page No. 10; NOTARY PUBLIC
Book No. 89; PTR No.0442385,01-11-10
Series of 2010. Until December 31,2011
Santiago City
Republic of the Philippines )
City of Santiago )SS

AFFIDAVIT OF LOSS

I, JOCELYN A. MAWIRAT, of legal age, Filipino, married, and a resident of


Lachica St., Rizal, Santiago City, after having been duly sworn in accordance with law,
hereby depose and state:

1. That I am the owner and holder of check under check no. 0393656 with an
amount of FIFTEEN THOUSAND PESOS (P15,000.00) issued by Land Bank of
the Philippines, Ilagan, Isabela Branch, Ilagan, Isabela;

2. That I have always kept the said check in my wallet which I always bring
everytime I go out;

3. That my wallet and its contents including the abovementioned check was
unfortunately lost sometime in November 23, 2009 in Buenavista, Santiago City;

4. That I have exerted diligent efforts to locate my wallet including its contents but in
vain; hence, the same are now considered lost beyond recovery;

5. That I am executing this affidavit to attest to the truth of the foregoing and to
support of my application for the replacement of my lost check.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of


November, 2009 at Santiago City.

JOCELYN A. MAWIRAT
affiant
DepEd I.D. No. 05056

SUBSCRIBED AND SWORN to before me this 23rd day of November, 2007 at


Santiago City, Philippines.

WITNESS MY HAND AND SEAL.

Doc. No. 2275; ATTY. ABRAHAM B. SABLE


Page No. 58; NOTARY PUBLIC
Book No. 86; PTR No.0333075,13-2009
Series of 2009. Until December 31,2009
Santiago City
Republic of the Philippines )
City of Santiago )SS

AFFIDAVIT OF LOSS

I, JONATHAN PRUDENCIO, of legal age, Filipino, and a resident of


Balintocatoc, Santiago City, after having been duly sworn in accordance with law, hereby
depose and state:

1. That I hold a Community Tax Certificate (sedula), Voter’s Affidavit Birth


Certificate, P200.00 and other Identification Cards which I usually placed in my
wallet;

2. That sometime on October 24, 2006, I placed my wallet containing the


aforementioned Professional Driver’s License, Community Tax Certificate
(sedula) and other Identification Cards on top of our cabinet in our house;

3. That when I returned, I found out that my wallet is no longer in the place where I
placed it earlier;

4. That I have tried all my effort to locate my wallet but in vain, hence, the same is
considered lost beyond recovery;

5. That I am executing this affidavit to attest to the truth of the aforementioned facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of October,


2006 at Santiago City.

RAMON A. GOMBIO
affiant

SUBSCRIBED AND SWORN to before me this 26th day of October, 2006 at


Santiago City.

ATTY. ABRAHAM B. SABLE


Notary Public
PTR No.0022636,1-4-2006
Doc No. 1937; Until December 31, 2007
Page No. 89; Santiago City
Book No. 51;
Series of 2006.