Republic of the Philippines )

City of Dumaguete ) S.S.

x - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, GRETCHEN CABAJON, of legal age, Filipino, single, and a resident

of Cangmating, Sibulan, Negros Oriental, Philippines, after having been duly
sworn in accordance with law, hereby depose and state:

1. That I am a member of PAG-IBIG and a holder of PAG-IBIG ID with

No. 1211-0244-4074.

2. That I used the said ID when I claimed my PRC ID in Iloilo City

sometime last year, 2016. However, when I went home, I discovered
that the said ID is no longer in my bag nor in my wallet.

3. That it might have fell off on my way back to Dumaguete.

4. That despite diligent search and efforts to locate my PAG-IBIG ID, I

could not find the same such that I now believe that it is now lost
beyond recovery;

5. As such, I am executing this Affidavit of Loss to attest to the truth of

the foregoing and to support the application for the issuance of new
one in lieu of the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 5th day of

September 2017 at Dumaguete City, Philippines.
 GRETCHEN CABAJON
AFFIANT

SUBCRIBED AND SWORN TO before me this 5th day of September 2017

at Dumaguete City Philippines, affiant exhibiting to me his valid proofs of
identificationher PRC ID with no. 0797996 which is valid until 3/8/2019.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.