Republic of the Philippines

Camiling, Tarlac

)
) S.S.

AFFIDAVIT OF LOSS
I, MARITESS RANES y NICOLAS, of legal age, Filipino citizen, married
and a resident of Barangay Sawat, Camiling, Tarlac, Philippines, under oath, do
hereby depose and state THAT:
1. I am a registered voter of Camiling, Tarlac, Philippines; thus, I was
issued a Voters Identification (ID) card which I usually keep inside my
wallet;
2. On November 28, 2016 in the morning, I took my wallet and went to the
Camiling Public Market, Camiling, Tarlac. After buying the stuffs I
needed, I went home;
3. Upon arriving home, I discovered that my wallet was missing.
Immediately, I went to the tricycle terminal and asked the tricycle driver
I boarded earlier if he has seen my wallet inside his tricycle but he
found nothing. Also, I went back to the store where I made my
purchases and asked the store attendants if ever if left or drop my
wallet inside their establishment but they answered in the negative;
4. Diligent efforts exerted to locate my wallet which contained my Voter ID
card and other personal belongings proved futile, hence, I now consider
them as lost and beyond recovery
5. My voter ID card was never pledged nor used to secure any obligation;
6. I am executing this affidavit to attest to the truth of the foregoing
statements and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of
December, 2016 at Camiling, Tarlac, Philippines.
MARITESS N. RANES
Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated
above. Affiant exhibited to me her Police Clearance with Control No.
20161205006 issued by the Camiling Police Station, Camiling, Tarlac issued on
December 5, 2016.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2016.