Republic of the Philippines )

______________________ ) S.S.

AFFIDAVIT OF LOSS

I, HARVEY E. GENAYAS, of legal age, Filipino citizen, married and

resident of Block 27, Lot 5, AFP Housing, Brgy. Bulihan, Silang, Cavite, after
being duly sworn to in accordance with law, hereby depose and state:

1. Sometime in April 2017, I went to at Brgy. San Dionisio, Parañaque

City, Metro-Manila, to celebrate its annual feast. However, when I
went home the following day after the said event, it was only such time
that I have discovered that my wallet containing the following items:
a.) Voter’s I.D.;
b.) SSS I.D.
c.) ATM Card issued by Banco De Oro (BDO);
d.) Passport I.D. and;
e.) Certain amount of cash.
were all missing and nowhere to be found;

2. I tried to search for the above-delineated items but I failed to locate the
same despite diligent efforts on my part. As such, the above-
enumerated items can now be considered completely lost and beyond
recovery;

3. I surmised that my wallet could have been unintentionally misplaced or

accidentally dropped by me when I was so inebriated during that day
or while I was on my way home or somewhere else;

4. As such, I am executing this Affidavit of Loss to attest to the truth of

the foregoing statement, to secure a replacement of the above
delineated items, and for whatever legal intents and purposes this may
serve.

AFFIANT FURTHER SAYS NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this

___________________ at __________________________, Philippines.

HARVEY E. GENAYAS
Affiant

SUBSCRIBED AND SWORN to before me, this __________________, by the

affiant whom I have identified through his Pag-IBIG Card No. 1210-8572-6804
issued at Biñas City, Laguna, which serves as his Competent Evidence/Proof of
Identity pursuant to the 2004 Rules on Notarial Practice.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.