REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BATANGAS ) S. S.
CITY OF TANAUAN )

AFFIDAVIT OF LOSS

I, ELENITA C. CULANG, 48 years old, married and a resident of #94 Tapia

Subdivision, Brgy. Pob. 6, Tanauan City, Batangas, after having been sworn to in
accordance with law, hereby depose and say THAT:

1. I am a bonafide resident of #94 Tapia Subdivision, Brgy. Pob. 6, Tanauan

City, Batangas;

2. On February 24, 2017 around three oclock in the afternoon, fire ensued
in our community causing damage and destruction to houses including my house;

3. Said fire burnt and destroyed all my personal and family belongings,
including but not limited to:

a. Social Security System (SSS) identification card (ID) issued by SSS;

b. Pagibig ID issued by Pagibig;
c. Voters ID issued by Comelec of Tanauan City, Batangas
d. Philhealth ID issued by Philhealth
e. TIN ID issued by Bureau of Internal Revenue (BIR)
f. Batelec ID issued by Batelec Batangas; and
g. Home Broadband devices issued by PLDT/Smart company.

4. On account of fire ensued and destruction of my house, I am now certain

that the above enumerated items/IDs safely kept in my house are now beyond
recovery;

5. I am executing this affidavit to attest to the truthfulness and veracity of

the foregoing statements, for the purpose of requesting for issuance of new
identification cards from concerned offices in lieu of those lost and for whatever
legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of March

2017 at Tanauan City, Batangas, Philippines.

ELENITA C. CULANG
Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of March 2017 at

Tanauan City, Batangas, Philippines, affiant exhibiting to me her Voters
Certification bearing her picture and signature to prove her identity.

HEART C. LERO
Public Attorney I
Pursuant to R.A. 9406