REPUBLIC OF THE PHILIPPINES )

CITY OF SAN FERNANDO ) S.S

AFFIDAVIT OF LOSS
I, ELOYD G. MALLARI, married, of legal age, Filipino citizen, and a resident of DPCH
Tarlac City after having been deposed in accordance with law, do hereby state.

1. That I am a holder of Public Safety Savings & Loan Association Inc., Identification Card
( PSSLAI ).

2. That sometime on April 2018, I placed my PSSLAI ID in my pocket while I’m driving a
motor vehicle.

3. That when I check my pocket, my PSSLAI ID was already gone and which I believed to
have been lost while I’m driving my motor vehicle on the Highway.

4. That despite due and diligent search made, the same could no longer found.

5. That I am executing this affidavit to attest to the veracity of the above-stated facts, for the
purpose of the issuance of a new PSSLAI ID or any other legal purpose which this affidavit
may serve.

AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto signed my signature this

_________________________at __________________________

ELOYD G. MALLARI

AFFIANT

SUBSCRIBED AND SWORN to before me this ___________________at

_____________ and showing to me his ID No.____________________issued at
________________________

Doc. No _______;
Page No._______;
Book No._______;
Series of 2019.