REPUBLIC OF THE PHILIPPINES)

Province of Southern Leyte) S.S.

City of Maasin )
x--------------------x

AFFIDAVIT OF LOSS

I, JOEL T. BALLADARES, Filipino, of legal age, single, and a resident of Rizal,

Macrohon, Southern Leyte, after having been sworn in accordance with law, do hereby
depose and state:

1. That, I am a holder of Voters ID issued by Commission on Election (COMELEC);

2. That, unfortunately the said Voters ID has been misplaced on September 17,
2017;

3. That, despite diligent search and efforts to locate the said Voters ID, I was not
able to find it;

4. That, I now believe that it is already lost beyond recovery; and

5. That, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and for issuance of the new Voters ID and to support for whatever legal
purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ____ 2017
at Maasin City, Southern Leyte, Philippines.

JOEL T. BALLADARES
Affiant

SUBCRIBED AND SWORN to before me this ___ day of _______, 2017 at Maasin City,
Southern Leyte, Philippines affiant exhibiting to me valid and competent proof of identity
indicated below his name.

Doc No.
Page No.
Book No. X, S. 2017