Republic of the Philippines

City of Davao
AFFIDAVIT OF LOSS
I, ______________________________ of legal age, Filipino and a
resident of ___________________, having been sworn to in
accordance with the law do hereby depose and say:

1. That I am the holder of _____________________________

issued by ______________________.
2. That the aforementioned identification
card/________________ was lost or misplace despite
diligence effort to locate the same but could no longer be
found;
3. That I am executing this affidavit to attest to the truth of the
foregoing statements and to support for whatever legal
purpose this my serve.

In witness whereof, I have hereunto affixed my signature this

_________________, in the City of Davao, Philippines.
______________________
Subscribed and sworn to before me this _______________ in the
City of Davao, Philippines.

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Series 2017