REPUBLIC OF THE PHILIPPINES} City of Talisay }S.s.

AFFIDAVIT OF LOSS
I, EDUARDO S. ABELLO, of legal age, Fili i!o, "a##ie$, a!$ a #esi$e!t of %& '()&, D*"log, Talisay City, Ce+*, *!$e# oat,, ,e#e+y $e ose a!$ say t,at.. So"eti"e i! &//0, I 1as #i$i!g a 2ee 1,e! "y 1allet 1as stole!3 &. A"o!g t,e ite"s i!si$e "y 1allet 1as "y So4ial Se4*#ity Syste" 5SSS6 I$e!tifi4atio! Ca#$ 1it, !o. /78.(&9:(;8/3 ). Des ite $ilige!t sea#4, a!$ effo#ts to lo4ate t,e sai$ ID, I 4o*l$ !ot fi!$ t,e sa"e s*4, t,at I !o1 +elie<e t,at it is !o1 lost +eyo!$ #e4o<e#y3 :. As s*4,, I a" e=e4*ti!g t,is affi$a<it to attest to t,e t#*t, of t,e fo#egoi!g, to s* o#t "y #e>*est fo# t,e #o4essi!g of a !e1 SSS ID i! #e la4e"e!t of t,e lost o!e a!$ fo# 1,ate<e# legal *# ose t,is "ay se#<e. IN ?ITNESS ?HEREOF, I ,a<e affi=e$ "y sig!at*#e t,is @@@@@@@@@@@@@@@@@ i! Talisay City, Ce+*, P,ili i!es.

EDUARDO S. ABELLO Affiant

SUBSCRIBED AND S?ORN to +efo#e "e t,is @@@@@@@@@@@@@@@@ i! Talisay City, Ce+*, P,ili i!es, affia!t ,a<i!g e=,i+ite$ to "e ,is P,ili i!e Pass o#t No. AA.((;/9/ <ali$ *!til B*ly 7, &/.).

Do4 No. @@@3 Page No. @@@3 Book No. ___; Se#ies of &/.).