AFFIDAVIT OF LOSS

Republic of the
Philippines

)
)

I, EDWARDSON D. MALANGEN, of legal age, Filipino, single, and a

resident of Zone 5, Brgy. Holy Friday, Mallig, Isabela, after duly sworn to in
accordance with law, do hereby declare to the best of my knowledge and
belief that:
1. I am a holder of the following Identification Cards (IDs):
ID / Type
Professional ID Card (Real
Estate Appraiser)
Professional ID Card (Real
Estate Broker)
TIN ID Card
GSIS eCard Plus
SSS ID Card

No.
0003402
0014724
935-206-938
0200407844
4
01-16754208

Issued by:
Professional Regulation
Commission
Professional Regulation
Commission
Bureau of Internal
Revenue
Government Service
Insurance System
Social Security System

2. That I used to put said IDs in my wallet, among others;

3. That sometime on July 5, 2014, when I arrived home from
work/seminar-workshop, I discovered that the above-specified IDs were
no longer in my pants/bag where I used to place it;
4. That despite diligent efforts to locate/find the same had proved futile
and unavailing, and to the best of my knowledge, the same were truly
lost;
5. That said IDs were not confiscated by the authorities by reason of any
violation of laws; and
6. That I am executing this affidavit to attest to all the above facts and to
request for replacement/re-issuance of IDs from the issuing/concern
authority.

IN WITNESS HEREOF, I have hereunto signed my name below this

of

day

, 2016 at

EDWARDSON D. MALANGEN
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ____ day of _____________,

_____________

in

________________________________________,

with

affiant

exhibiting to me his Residence Certificate No. 18344540 issued at Brgy. Holy

Friday, Mallig, Isabela on March 17, 2016.

NOTARY PUBLIC
Doc. No.
Page No.
Book No.
Series of 2016