Republic of the Philippines)

Municipality of ) S.S.
City/Municipality of )

AFFIDAVIT OF LOSS

I, Meriza D Romano, Filipino, of legal age, and residing in A. Bartolome

Ext. Malanday Valenzuela, after having sworn according to the law, hereby depose and
state that:

1. I am the owner of Sun Life Finacial ID issued on September 01, 2018.

2. On or about March 2020, I discovered the loss of the said item.
3. Despite diligent effort, I could not find nor locate the same and I believe that
it is truly lost.
4. I am executing this affidavit for whatever legal purpose it may serve.

I am executing this affidavit and vouched for the true facts – for whatever legal purpose it
may serve.

Meriza D. Romano

____________________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of

______________at____________ with affiant exhibiting her Community Tax Certificate
No._____________ issued at ____________________on_________________.

Doc. No.: Notary Public

Page No.:
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