Republic of the Philippines)

SANTIAGO CITY ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, MICHAEL T. ORDONIO of legal age, Filipino, married, and a resident of

No. 123 Malvar St., Santiago City, after having been sworn in accordance with law, hereby
deposes and states the following:

1. I am holder/owner/ or possessor of the following identification card / document:

PRC ID, DRIVER’S LICENSE, GSIS ID, PNB ATM CARD, and METROBANK ATM
CARD;

2. I have recently discovered the said items are irretrievably lost and can no longer
be found despite diligent efforts to locate the same;

3. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

MICHAEL T. ORDONIO
Affiant
SSS ID No. 33-8867051-5

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below.
The affiant exhibited to me his competent evidence of identity as indicated above.
Signed this 21st day of March, 2018 at Santiago City, Isabela, Philippines.

WITNESS MY HAND AND SEAL.

ATTY. JOANNE NATIVIDAD

Appointment No. 123
NOTARY PUBLIC
Santiago City
Until Dec. 31, 2018
Unit 1, X Bldg., Santiago City
IBP No. 123456; 01/10/16-Manila
 PTR. No. 123456; 01/10/16-Manila
Roll No. 12345; 01/28/10
MCLE No. 1-00124; 09/09/15
MCLE No. 11-005678; 09/09/15

Doc. No. 0413

Page No. 5
Book No. 175
Series of 2018