Republic of the Philippines )

Camiling, Tarlac
) s.s

AFFIDAVIT OF LOSS
I, FERY SUNDAY JABON y PUBLICO, of legal age, Filipino citizen, single
and a resident of Baltazar St., Poblacion E, Camiling, Tarlac, after having been
duly sworn to in accordance with law, do hereby depose and state THAT:
1. On October 17, 2016, I placed my wallet in the pocket of my pants and
went to Patar, Bolinao, Pangasinan together with my family for an
outing;
2. My wallet contained my Professional Drivers License Card, some cash
and other personal belongings;
3. After spending the whole day in Patar, Bolinao, Pangasinan, we decided
to go home. Later that day, I was very exhausted and after reaching my
place, I took off my pants, hung inside my room and went to bed. The
next morning, I was preparing to go out and I discovered that my wallet
was missing from the pocket of my pants;
4. I immediately searched my wallet inside my room but I found nothing. I
also asked my household members if they have seen my wallet but they
answered in the negative;
5. All efforts exerted to locate the said wallet containing the said
professional drivers license card and other personal belongings proved
futile; hence, I now consider them as lost and beyond recovery;
6. My professional drivers license card was neither confiscated by any
authority nor pledged to secure any obligation;
7. I am executing this Affidavit to attest to the truth of the foregoing
statements and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd day of
December, 2017 at Camiling, Tarlac, Philippines.
FERY SUNDAY P. JABON
Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated
above. Affiant presented before me his Unified Multi-Purpose ID card with CRN0111-4810145-9 issued by the Social Security System of the Philippines.

Doc. No.__________; Page No.__________; Book No._________; Series of 2017.