Republic of the Philippines )

Malolos City, Bulacan

) S.S.

AFFIDAVIT OF LOSS
I, MARC SHERWIN R. CARLOS, of legal age, Filipino and a resident
of Blk 4 Lot 3 Hagonoy Subdvision, Hagonoy, Bulacan, after having
been duly sworn to in accordance with law hereby depose and say
that:
1. That I am the holder of the following documents namely:
SSS Identification Card
Issued by Social Security System (SSS)
Voters Identification Card
Issued by COMELEC Hagonoy, Bulacan
PHILHEALTH IDENTIFICATION CARD
Issued by Philippine Health Card
NOPTI IDENTIFICATION CARD
Issued by National Organization of Professional
Teachers Inc. and
Original Receipt of Pictures
2. That the above-named documents were lost and/or misplaced
due to unknown reason and inspite diligent effort to locate the
same could not be found;
3. That said documents were not confiscated nor apprehended
by any competent authorities for violation of any rules and
regulations pertaining said documents.
4. That this affidavit is executed for the purpose of informing
authorities concerned about the loss of the said documents,
requesting them to issue replacements of the same and
further for all legal intents and purposes this may serve best.
IN WITNESS WHEREOF, I have hereunto set my hand this 18th
day of May, 2007, hereat Malolos City, Bulacan.
MARC SHERWIN R. CARLOS
Affiant
CTC NO. 06111717
Issued at Hagonoy, Bulacan
On 1-23-07
SUBSCRIBED AND SWORN TO before me this 18 th day of May,
2007, here at Malolos, Bulacan.