Republic of the Philippines)

Province of  Cavite ) S.S.

Municipality of Alfonso ) 

AFFIDAVIT OF LOSS

I, JOSIE P. VIDALLO, Filipino, of legal age, and a resident of Alfonso,

Cavite, after being duly sworn to in accordance with law, hereby depose and state:

1. On September 1, 2020 at around 11:30 a.m., my son accidentally dropped my

(GSIS) Unified Multi-Purpose ID and PRC ID;

2. Despite diligent search and efforts to recover said identification cards the
same can no longer be located;

3. I am executing this affidavit not for any unlawful purpose but only for the
purpose of application for replacement of the said Unified Multi-Purpose ID
and PRC ID.

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day of September,

2019 at Province of Cavite, Philippines.

JOSIE P. VIDALLO
Affiant

SUBSCRIBED AND SWORN to before me this 4th day of September, 2020 at

Alfonso, Cavite. Affiant personally appeared to this office.

WITNESS MY HAND AND SEAL.

Doc. No. 106 ;

Page No. 23 ;
Book No. LXXXIV;
Series of 2020.