Republic of the Philippines )

Province of La Union ) S.S.

Municipality of Naguilian ) 

AFFIDAVIT OF LOSS

I, RON VERA PEREZ, of legal age, Filipino citizen, widower and a resident of No.
143 Naguilian Road, Ortiz, Naguilian, La Union, Philippines, after being duly sworn
in accordance with law, depose and state:

That I am the owner of a one (1) unit of pistol Caliber 380 firearm with Serial No.
xxxxx.

That sometime on 2015, when I was about to renew my permit to carry my firearm, I
discovered that my firearm, some ammunition, and my license to carry the same were
missing;

That the black bag/case placed in the front compartment of my vehicle is there so I
had not doubted that the contents were gone;

That despite diligent search and efforts to locate said firearm, I could not find the
same such that I now believe that all the foregoing items were stolen and are now lost
beyond recovery.

As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ of April, 2019 at
Naguilian, La Union, Philippines.

RON VERA PEREZ

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ___ day of April,

2019 at Naguilian, La Union, Philippines by affiant who is personally known to me
and upon showing to me his Senior Citizen ID No. 12345 issued by the Office of the
Senior Citizens Affairs, Naguilian, La Union as proof of his identity.