Republic of the Philippines)

City of Taguig ) S.S.

AFFIDAVIT OF LOSS

I, ROLANDO C. VASQUEZ, of legal age, Filipino Citizen, with residence

and postal address at 34-C Gemini St., Brgy. Sto. Domingo, Villarica Subd.,
Cainta, Rizal, after having duly sworn to in accordance with law do hereby
depose and state:

That I am an owner and holder of the following items:

1. Company ID, issued by Leopard Security & Investigation Agency;

2. SSS Digitized ID Card issued by the Social Security;
3. Professional Driver’s License and its corresponding Official
Receipt (O.R.), issued by Land Transportation Office;
4. PHILHEALTH ID Card;
5. Pag-IBIG Fund ID Card;

That on April 29, 2016, at around 9 o’clock in the evening, upon arriving at
my residence coming from work, I found out that my cardholder containing the
aforementioned items, was already missing, probably it fell on the road while I
was driving from work going to my residence;

That I exerted all efforts to locate or find the aforementioned items, but
proved futile and meaningless whatsoever;

That I am executing this AFFIDAVIT to attest to the truth and veracity of

the above statements for all LEGAL INTENTS and PURPOSES it may serve
best.

IN WITNESS HEREOF, I have hereunto signed my name this 24 th day of

May 2016 at Taguig CIty, Metro Manila.

ROLANDO C. VASQUEZ
Affiant

SUBSCRIBED & SWORN TO BEFORE ME THIS 24 th day of May 2016 at

Taguig City, Metro Manila, affiant exhibiting to me his Security License Card No.
039689009, issued by PNP Civil Security Group.

ATTY. VOLTAIRE BAN L. DELOS

REYES
Doc. No. ___. Notary Public
Page No. ___. Cities of Taguig, Pasig, San Juan and Pateros
Book No. VI . Commission Appointment No. 80(2015-2016)
Series of 2016. Until December 31, 2016/ MCLE NO. IV-0018532
IBP Lifetime Member No. 013905; Cavite / Roll No.
61669
PTR No. A-2601004;1-05-2016; Taguig City
B25 L39, Upper Bicutan, Taguig City