REPUBLIC OF THE PHILIPPINES )

City of Roxas ) S.S.

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AFFIDAVIT OF LOSS

I, AILEEN B. ABELLANO, Filipino, of legal age, married and a resident

of Brgy. Angub, Cuartero, Capiz, after having been duly sworn in
accordance with law, hereby depose and state:

1. That I am a holder of a UMID I.D, duly issued by the GSIS;

2. That the said UMID I.D and its whereabouts could not be
ascertained;

3. That diligent efforts to locate and search in places where I have

been on that day, I lost it; However, said UMID I.D was nowhere
to be found;

4. That said UMID Identification Card was not confiscated by the

authorities by any reason. Neither I violated any rules and
regulations;

5. That I am executing this affidavit to attest to the truth of the

foregoing facts and to request for a replacement of said UMID I.D.

IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of

March, 2020 at the Roxas City, Philippines.

AILEEN B. ABELLANO
PRC I.D No. 0452699

SUBSCRIBED AND SWORN to before me this 6th day of March,

2020 in the City of Roxas, Philippines. I further CERTIFY that I have
personally examined the affiant, and I am fully satisfied that she voluntarily
executed the foregoing Affidavit, and she read and understood the contents
thereof.