Republic of the Philippines)

Province of  Cavite ) S.S.

Municipality of Alfonso ) 

AFFIDAVIT OF LOSS

I, EMILIO C. COLUMNA JR., Filipino, of legal age, with residence address at

009 Zamora St. Brgy. 4, Alfonso, Cavite, after being duly sworn to in accordance with
law, hereby depose and state:

1. On July 19, 2020, on or about 2:30 p.m. while I was in Sinaliw Malaki, Alfonso,
Cavite, I accidentally dropped my wallet;

2. Included inside my wallet are the following;

a) Brgy. ID issued by Barangay 4, Alfonso, Cavite;
b) Non-Professional Driver’s License issued by Land Transportation Office (LTO-
Tagaytay); and
c) Quarantine Pass/ID

3. Despite diligent search and efforts to recover the said Identifications (ID’s) the
same can no longer be located;

4. I am executing this affidavit not for any unlawful purpose but only for the
purpose of application for replacement of the said Identifications;

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of July, 2020
at Province of Cavite, Philippines.

EMILIO C. COLUMNA JR.

Affiant

SUBSCRIBED AND SWORN to before me this 20th day of July, 2020 at

Alfonso, Cavite. Affiant personally appeared to this office.

WITNESS MY HAND AND SEAL.

Doc. No. 389 ;

Page No. 70 ;
Book No. LXXXII;
Series of 2020.