Republic of the Philippines)

City of Manila..)S.S
AFFIDAVIT OF LOSS
I, ROMEO S. LANDA, of legal age, single, Filipino, with residence and
post-office address at No. 368 San Diego Street, Sampaloc, Manila, after
having been duly sworn to in accordance with law do hereby depose and
state:
1. That I am a holder of the following I. D. To wit;
A) GSIS I.D.
B) D.P.S. I.D.
C) BIR I. D.
2. That sometime July of this year 2016, on my way home, I have
noticed that my wallet containing, some money and the aforementioned I. D.s was inadvertently lost;
3. That despite all diligent effort to look for the missing wallet with its
contents and exerted to locate the same but to no avail;
4. This I have executed this affidavit in order to attest to the truth and
veracity of the foregoing and for whatever legal purpose it may
serve;
AFFIANT FUTHER SAYETH NAUGHT
IN WITNESS WHEREOF, I have hereunto set my hand 8 th day of August
2016, in the City of Manila, Philippines.
ROMEO S. LANDA
Affiant
SUBSCRIBED AND SWORN to be before me this 8 th day of August
2016, in the City of Manila, Philippines.
WITNESS MY HAND AND SEAL, the day year, and place above written.