Affidavit of Loss

Republic of the Philippines)
:
IN THE CITY OF PAGADIAN)SS.
AFFIDAVIT OF LOSS
(4P’s IDENTIFICATION CARD)
I, ARNOLFO B. COHIDOR, of legal age, Filipino, married and a resident of

Purok Bakhaw B., Kawit, Pagadian City, Zamboanga del Sur, after having been duly
sworn to in accordance with law, do hereby depose and say:
That I am a bona fide grantee of Pantawid Pamilyang Pilipino Program (4 P’s);
That as such, I am a holder/possessor of a 4 P’s Identification Card;
That said Identification Card was placed in my wallet, however, said wallet is
gone sometime on May 13, 2013. I discovered the loss only after I reach my house from
the city public market;
That I took diligent effort to locate the same but the my efforts proves futile and
fruitless and I honestly believed that it was lost and the possibility to retrieve the same is
very remote;
That I am executing this affidavit to attest the veracity of the foregoing statement
and for any legal purposes that this may serves best .
IN WITNESS WHEREOF, I have hereunto set my hand this May 23, 2013 at
Pagadian City, Philippines.
ARNOLFO B. COHIDOR
Affiant
SUBSCRIBED AND SWORN TO before me this May 23, 2013 at Pagadian City
Philippines. Affiant exhibited tome his PhilHealth I.D No. 1295-7016-020-166.
:
AFFIDAVIT OF LOSS
(Driver’s License)
I, EDWIN EBINA GUMAHAD, of legal age, married, Filipino, and a resident

Panubigan, Pitogo, Zamboanga del Sur, after having been duly sworn to in accordance
with law, do hereby depose and say:
That I am a law abiding citizen and a holder of a Professional driver’s license

which will expire on ___________________ bearing License No.
___________________ ;
That sad to note that said driver’s license was lost together with my wallet in my
possession sometime last Saturday, July 21, 2012 within the vicinity of down town
Pagadian, it might be fallen while boarding a passenger vehicle or misplaced or taken by
some bad elements;
That despite diligent effort to locate the same but the same is fruitless and I
honestly believed that it was lost and the possibility to retrieve the same is very remote;
IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of July,

2012 at Pagadian City, Philippines.
EDWIN EBINA GUMAHAD

Affiant
SUBSCRIBED AND SWORN TO before me this 25 th day of July 2012 at

Pagadian City Philippines.
Doc. No.
Page No.
Book No.
SERIES OF 2012
:
AFFIDAVIT of LOSS
(Re: PAWNSHOP RECEIPT)
I, SHESYL UKAM, of legal age, Filipino, single and a resident of Bomba,

Pagadian City, Zamboanga del Sur, after having been duly sworn to in accordance with
law, do hereby depose and say:
That on April 25, 2012, I pledged my ring, weighting 1.1 grams, in the amount of
P2,000, at F.A. Pawnshop, Pagadian City and they issued in my favor pawn receipt with
number 205083;
That just recently, said pawn receipt was no longer in my possession it might be
fallen or taken by some bad elements or misplace in our house;
That despite effort to locate the same is fruitless and I believe it was inadvertently
lost, hence, this affidavit;
That I am executing this affidavit to attest to truth of the foregoing statements and
for any legal purpose this may serve;

SHESYL UKAM
Affiant

Doc. No. 27
Page No. 5
Book No. XVI
SERIES OF 2012
:
AFFIDAVIT of LOSS
I, JESSICA PATAGOC, of legal age, Filipino, married and a resident of San

Pablo, Zamboanga del Sur, after having been duly sworn to in accordance with law, do
hereby depose and say:
That on February 19, 2012, I pledged my Chocker, weighting 2.3 grams, in the
amount of P2,800, at F.A. Pawnshop, Pagadian City and they issued in my favor pawn
receipt with number 207696;
That just recently, said pawn receipt was no longer in my possession;

JESSICA PATAGOC
Affiant

Doc. No. 26
Page No. 5
Book No. XVI
SERIES OF 2012
:
AFFIDAVIT
I, PEDRITA D. AYING, of legal age, widow, Filipino, and a resident Santa

Lucia District, Pagadian City, after having been duly sworn to in accordance with law, do
That I am a law abiding citizen and a bona fide self member of the Social
Security System (SSS) bearing SSS No. _______________;
That since May, 2012, I have no more income/earnings and have already ceased
my business as street ambulant vendor, attached please find the Barangay Certification to
form an integral part hereof;
IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of

September 2012 at Pagadian City, Philippines.
PEDRITA D. AYING
Affiant
SUBSCRIBED AND SWORN TO before me this 17 th day of September 2012 at

Doc. No.
Page No.
Book No.
SERIES OF 2012
:
AFFIDAVIT OF LOSS
I, JULIE AROCHA, of legal age, widow, Filipino, and a resident Balangasan

District, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
accordance with law, do hereby depose and say:
That I am a law abiding citizen and a holder of a Non-Professional driver’s

license which will expire on ___________________ bearing License No.
___________________ ;
That sad to note that said driver’s license was lost together with my wallet in my
possession sometime last Saturday within the vicinity of down town Pagadian, it might
be fallen while boarding a passenger vehicle or misplaced or taken by some bad
elements;
IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of June, 2012
at Pagadian City, Philippines.
JULIE AROCHA
Affiant
SUBSCRIBED AND SWORN TO before me this 6 th day of June 2012 at

Doc. No.
Page No.
Book No.
SERIES OF 2012
:
AFFIDAVIT of LOSS
(Re: FCB PASSBOOK and ATM CARD)
I, BELENDA C. TABIOLO, of legal age, Filipino, married and a resident of San

That I am a law abiding citizen and that I am a bonafide depositor of FIRST

CONSOLIDATED BANK, Molave Branch, and a holder and possessor of a PASSBOOK
and ATM CARD bearing FCB ACCT. NO. 02402010047114 and PITAKArd No. 6064
2902 4000 2388, respectively;
That said bank documents was lost in my possession together with my wallet
sometime last October 2011 somewhere in the vicinity of downtown Pagadian, it might
be fallen or taken by some bad elements, and I tried to locate the same but nowhere to be
found;
That I am executing this affidavit to attest the truth of the foregoing statements
and for any legal purpose this may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of June,

BELENDA C. TABIOLO
Affiant

Doc. No. 28
Page No. 6
Book No. XVI
SERIES OF 2012
:
AFFIDAVIT of LOSS
(Re: DRIVER’S LICENSE)
I, HILARION M. VILLAHERMOSA, of legal age, Filipino, single and a resident

of Dimataling, Zamboanga del Sur, after having been duly sworn to in accordance with
That I am a law abiding citizen and that I am a bonafide holder and possessor of a
Driver’s License duly issued in my name by the Land Transportation Office (LTO)
bearing License No. ____________________;
That said driver’s license was lost in my possession together with my wallet
sometime last June 11, 2012 somewhere in the vicinity of downtown Pagadian, it might
found;

HILARION M. VILLAHERMOSA
Affiant

Doc. No. 28
Page No. 6
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: DRIVER’S LICENSE, et al)
I, LORENZO M. ASUELO JR., of legal age, Filipino, married and a resident of

Gatas District, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
bearing License No. ________________;
That said driver’s license was lost in my possession sometime last June 11, 2012
somewhere in SM Cebu and sad to note that said driver’s license was lost together with
my wallet and some other important documents such as, SENIOR CITIZEN ID, METRO
BANK & BPI CREDIT CARD, and BPI ATM CARD, it might be fallen or taken by
some bad elements, and I tried to locate the same but nowhere to be found;

LORENZO M. ASUELO JR.

Affiant

Doc. No. 26
Page No. 5
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT OF LOSS
(ZSMIT SCHOOL IDENTIFICATION CARD)
I, RIZA L. ABELLANOSA, of legal age, Filipino, single and a resident San
That I am a law abiding citizen and a former bonafide student of ZSMIT,

Pagadian City First Year taking up Bachelor in Science in Mass Communication
(BSMC) School Year 2004-2005;
That as such, I am a holder/possessor of a SCHOOL IDENTIFCATION CARD

bearing IDNo. __________________;
That sad to note that said IDENTIFICATION CARD was lost in my possession
sometime last year when I tried to locate in my file cabinet, but the same were cannot be
located, it might be misplaced or totally lost;

RIZA L. ABELLANOSA
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2012
:
AFFIDAVIT of LOSS
(Re: MLHUILLIER PAWNSHOP RECEIPT)
I, SYLVIA H. TAMALA, of legal age, Filipino, married and a resident of Tongao,

Pitogo, Zamboanga del Sur, after having been duly sworn to in accordance with law, do
That I am a law abiding citizen and that I am an owner of a neck lace with
pendant;
That said jewelry was pawned at MLHUILLIER Pawnshop, Tongao, Pitogo
Branch sometime last June 2012 and sad to note that said official receipt bearing OR No.
0486-2011-02550 was lost in my possession together with my wallet, it might be fallen or
taken by some bad elements, and I tried to locate the same but nowhere to be found;
IN WITNESS WHEREOF, I have hereunto set my hand this 5 th day of July, 2012
SYLVIA H. TAMALA
Affiant

Doc. No. 25
Page No. 5
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: PHILIPPINE PASSPORT)
I, ABDULSATAR B. TUMOG, of legal age, Filipino, married and a resident of

Labangan, Zamboanga del Sur, after having been duly sworn to in accordance with law,
do hereby depose and say:
That I am a law abiding citizen and that I am a holder/possessor of a Philippine

Passport bearing Passport No. ___________________ which will expire on
___________;
That sad to note that said passport was lost sometime last May, 2012, it might be
misplaced, and I tried to locate the same but nowhere to be found, attached hereto is the
police blotter to form an integral part hereof;

ABDULSATAR B. TUMOG
Affiant

Doc. No. 19
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: PLATE NUMBER)
I, CARL LAURENCE BADIANG RUALES , of legal age, Filipino, single and a

resident of Purok Sandayong, Sto. Niño District, Pagadian City, Zamboanga del Sur, after
having been duly sworn to in accordance with law, do hereby depose and say:
That I am a law abiding citizen and that I am an owner of a single motorcycle

duly registered in my name by the Land Transportation Office bearing OR No.
168055893 and CR NO. 11169835-6: said motorcycle is more particularly described as
follows:
Make: HONDA
Frame/Chassis: KWY10116473
Model: WAVE Color: Black
Engine: KWY00E116473 Plate No: 3205 JK
That sad to note, the plate number of the said motor vehicle was lost somewhere
in Oroquieta City sometime last May 26, 2012 which was driven by my father JESSIE P.
RUALES, extract of the Police Blotter hereto attached to form an integral part hereof;

CARL LAURENCE BADIANG RUALES

Affiant

Doc. No. 26
Page No. 6
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
I, MELQUIADES C. GOTONG JR., of legal age, Filipino, married and a resident

of San Pedro District, Pagadian City, Zamboanga del Sur, after having been duly sworn
to in accordance with law, do hereby depose and say:
That I am a law abiding citizen and that I am an owner of a ring weighing 2.1
grams;
That said jewelry was pawned at Sun Gate Pawnshop, Jamisola Street Branch
sometime last December 23, 2011 and sad to note that said official receipt bearing OR
No. GA0004665 was lost in my possession together with my wallet, it might be fallen or
taken by some bad elements, and I tried to locate the same but nowhere to be found;
MELQUIADES C. GOTONG JR
Affiant

Doc. No. 25
Page No. 5
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: STOCK CERTIFICATE)
I, LUZVIMINDA D. DE LA PEÑA, of legal age, Filipino, widow and a resident of

Poblacion A, Midsalip, Zamboanga del Sur, after having been duly sworn to in
That I am a law abiding citizen and that I am the legitimate wife of the late
EDDIE D. DE LA PEÑA who died intestate last March 19, 2012;
That my late husband is a bona fide member of the Philippine Army Finance
Center Producers Integrated Cooperative bearing Member No. 047420 and as such, he
was issued a Stock Certificate;
That sad to note, said Stock Certificate was lost and/or cannot be located;

LUZVIMINDA D. DE LA PEÑA
Affiant

Doc. No. 25
Page No. 5
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of UNDERTAKING
(Re: PROOF OF MEMBERSHIP)
I, LUZVIMINDA D. DE LA PEÑA, of legal age, Filipino, widow and a resident of

Poblacion A, Midsalip, Zamboanga del Sur, after having been duly sworn to in
That I am a law abiding citizen and that I am the legitimate wife of the late
EDDIE D. DE LA PEÑA who died intestate last March 19, 2012 and a retired member of
the Philippine Army;
That my late husband is a bona fide member of the Philippine Army Finance
Center Producers Integrated Cooperative (PAFCPIC) bearing Member No. 047420 and as
such, he was issued a Stock Certificate;
That I shall undertake to received all benefits due to my late husband and oblige
myself to be responsible whatever and manifest freely that the PAFCPIC has no more
liability after issuance of the said claims;
That further manifest that I am executing this affidavit freely and voluntarily;

LUZVIMINDA D. DE LA PEÑA
Affiant

Doc. No. 26
Page No. 6
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: PLATE NUMBER)
I, NICOMEDES B. NINAL, of legal age, Filipino, married and a resident of Upper

Lumboy, Tuburan District, Pagadian City, Zamboanga del Sur, after having been duly
That I am a law abiding citizen and that I am an owner of a single motorcycle

acquired thru NORKIS Distributors Inc., attached please find the Certification to form an
integral part hereof: said motorcycle is more particularly described as follows:
Make: YAMAHA Frame: LAPXCHLA480023609

Model: CRYPTON SN Color: Blue
Engine: 5AV-631789 Plate No: JC-3189
That sad to note, said vehicle was car napped last June 5, 2012 and was recovered
at Dao, Pagadian City, unfortunately, the plate number of the said motorcycle were
already detached and/or removed and it might be thrown somewhere else, and I tried to
locate the same but nowhere to be found; the said incident was duly reported in the
proper authorities;

NICOMEDES B. NINAL
Affiant

Doc. No. 25
Page No. 5
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
I, RADIA MOHAMMAD, of legal age, Filipino, married and a resident of

That I am a law abiding citizen and that I am an owner of a bracelet weighing 8.9
grams;
That said jewelry was pawned at F.A. Pawnshop, Pulmones Avenue Branch
sometime last March 13, 2012 and sad to note that said official receipt bearing OR No.
203109 was lost in my possession together with my wallet, it might be fallen or taken by
some bad elements, and I tried to locate the same but nowhere to be found;
IN WITNESS WHEREOF, I have hereunto set my hand this 1 st day of June, 2012
RADIA MOHAMMAD
Affiant
SUBSCRIBED AND SWORN TO before me this 1 st day of June 2012 at

Doc. No. 25
Page No. 5
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: GSIS E-CARD)
I, BELENDA C. TABIOLO, of legal age, Filipino, married and a resident of

Marcos Village, San Pablo, Zamboanga del Sur, after having been duly sworn to in
That I am a law abiding citizen and a public school teacher presently assigned at
M. Marcos Elementary School, San Pablo, Zamboanga del Sur;
That as such, I am a bona fide member of the Government Service Insurance

System (GSIS) and was issued a GSIS e-CARD bearing CRN 006-0106-1092-1, sad to
note that said card enclosed with my wallet including all the items therein and some
amount of cash were lost, it might be misplaced or taken by some bad elements, and I
tried to locate the same but nowhere to be found;
IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of May,

BELENDA C. TABIOLO
Affiant
SUBSCRIBED AND SWORN TO before me this 30 th day of May 2012 at

Doc. No. 22
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: DRIVER’S LICENSE)
I, RIC VINCENT S. MARTIN , of legal age, Filipino, single and a resident of Sta.
Maria District, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
bearing License No. ________________;
That said driver’s license was lost in my possession sometime last May 12, 2012
and sad to note that said driver’s license was lost together with my wallet within the
vicinity of B.E., it might be fallen or taken by some bad elements, and I tried to locate the
same but nowhere to be found;

RIC VINCENT S. MARTIN

Affiant

Doc. No. 22
Page No. 4
Book No. XVI
SERIES OF 2012
:
AFFIDAVIT of LOSS
(Re: CASH CARD LAND BANK)
I, CALIXTO MALALAY JR, of legal age, Filipino, single and a resident of

That I am a law abiding citizen and a student of Southern Mindanao Colleges,

Pagadian City;
That I am a grantee of the Special Program for the Employment of Student

sponsored by the DOLE and assigned at Southern Mindanao Colleges, Pagadian City and
as such I am a holder and possessor of a Cash Card duly issued in my name by the Land
Bank of the Philippines;
That sad to note, that sometime last April 30, 2012 at while riding a side car
passenger motorcycle from Pagadian to Legarda, Dinas, I noticed that my wallet were no
longer in my possession, it might be fallen or taken by some bad elements, I tried and the
same is nowhere to be found;

CALIXTO MALALAY JR.

Affiant

Doc. No. 20
Page No. 4
Book No. XVI
SERIES OF 2012
:
AFFIDAVIT of LOSS
(Re: ORIGINAL SUBDIVISION PLAN)
I, CHARLES V. LAGNASON, of legal age, Filipino, married and a resident of

Dumagoc, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
That I am a law abiding citizen and that;
That I am one of the legal heirs of the late PAULA LAGNASON, who owned a
parcel of land located at Baga, Dumalinao, Pagadian City covered by OCT NO. P-5890
in the name of Catalino Lagnason;
That said parcel of land was being subdivided and covered by Lot 6444, Pls-119
containing an area of around 79,658 SQ, duly surveyed by Arcadio B. Cuizon and duly
approved by the Chief Regional Surveys Division, ENGR. BUENAVENTURA
DAGANDAN; PSD-09-029843;
That said ORIGINAL COPY of the said subdivision plan was lost in my
possession long time ago, it might be misplaced or lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 25 h day of May,

CHARLES V. LAGNASON
Affiant
SUBSCRIBED AND SWORN TO before me this 25 h day of May 2012 at

Doc. No. 20
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: CHINA BANK ATM CARD)
I, ALEX E. BOAQUIÑA, of legal age, Filipino, married and a resident of Best

Emporium, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
That I am a law abiding citizen and an employee of Best Emporium, Pagadian

City;
That I am a member/depositor of China Bank, Pagadian City Branch and a

holder/possessor of an ATM CARD bearing Account No. 269-059811-1;
That sad to note, that sometime last April 19, 2012 at about 7:00 in the evening
while riding a side car passenger motorcycle from BE, Pagadian to our home in Nazareth,
Buenavista, I noticed that my wallet were no longer in my possession, it might be fallen
or taken by some bad elements, I tried and the same is nowhere to be found;
IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of May,

ALEX E. BOAQUIÑA
Affiant
SUBSCRIBED AND SWORN TO before me this 23 rd day of May 2012 at

Doc. No. 20
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: Transcript Of Record)
I, JED MARTIN V. QUIDET, of legal age, Filipino, single and a resident of

Ramon Magsaysay, Zamboanga del Sur, after having been duly sworn to in accordance
That I am a law abiding citizen and a former student of St. Columban Colleges,
Pagadian City;
That sad to note, that sometime last SY 2008-2009, I transferred at ZSMIT,

Pagadian City and requested my Transcript of Records with the former school (St.
Columban College) but unfortunately, I was not able to turn it over to the ZSMIT due to
the fact that I did not finished the whole semester and went to Manila to search for a
greener pasture, now that I decided to come back schooling, I tried and the same is
nowhere to be found;
IN WITNESS WHEREOF, I have hereunto set my hand this 22 nd day of May,

JED MARTIN V. QUIDET

Affiant
SUBSCRIBED AND SWORN TO before me this 22 nd day of May 2012 at

Doc. No. 20
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: B.I.R. TIN CARD)
I, ARABELLA S. TAPODOC, of legal age, Filipino, married and a resident of

Tapodoc, Labangan, Zamboanga del Sur, after having been duly sworn to in accordance
That I am a law abiding citizen and;
That I am a bona fide TAX PAYER and holder/possessor of TAX

IDINTIFICATION NUMBER (TIN) bearing No TIN NO. __________________, sad to
note that said TIN I.D. was lost in my possession together with my wallet sometime last
month somewhere in down town Pagadian City, it might be fallen or taken by some bad
elements, and I tried to locate the same but nowhere to be found;

ARABELLA S. TAPODOC
Affiant

Doc. No. 20
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: T.I.N., SSS, PHILHEALTH, etc..)
I, CRESANIE CRISTORIA BETACHE, of legal age, Filipino, married and a
resident of Dimataling, Zamboanga del Sur, after having been duly sworn to in
That I am a law abiding citizen and that I am a professional teacher;
That I am a holder/possessor of a BIR T.I.N. #______________________, SSS

CARD # ___________________, PHILHEALTH # ____________________, and
VOTER’S I.D. # ______________________, sad to note that the above-mentioned
identification cards were lost in my possession together with my wallet sometime last
May 11, 2012 somewhere in Zamboanga City, it might be fallen or taken by some bad
elements, and I tried to locate the same but nowhere to be found;

CRESANIE CRISTORIA BETACHE

Affiant

Doc. No. 21
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: PHILIPPINE PASSPORT)
I, NOVO M. SUARIN, of legal age, Filipino, married and a resident of Poblacion

That I am a law abiding citizen and that I am a holder/possessor of a Philippine
Passport bearing Passport No. XX4182836 which will expire on 2014;
That sad to note that said passport was lost sometime last April 20, 2012, it might
found, attached hereto is the police blotter to form an integral part hereof;
IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of April,

NOVO M. SUARIN
Affiant
SUBSCRIBED AND SWORN TO before me this 30 th day of April 2012 at

Doc. No. 19
Page No. 4
Book No. XVI
SERIES OF 2012
:
AFFIDAVIT of LOSS
I, JULIET C. ASEÑAS, of legal age, Filipino, married and a resident of Golictop,

Midsalip, Zamboanga del Sur, after having been duly sworn to in accordance with law,
That I am a law abiding citizen and that I am an owner of an earrings (2 pcs)

weighing 1.8 grams;
That said jewelry was pawned at Mlhuiller Pawnshop, Rizal Avenue Branch
sometime last January 14, 2012 and sad to note that said official receipt bearing OR No.
2012-00127 was lost in my possession together with my wallet within the vicinity of
B.E., it might be fallen or taken by some bad elements, and I tried to locate the same but

JULIET ASEÑAS
Affiant

Doc. No. 20
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
I, JULIET C. ASEÑAS, of legal age, Filipino, married and a resident of Golictop,

Midsalip, Zamboanga del Sur, after having been duly sworn to in accordance with law,
That I am a law abiding citizen and that I am an owner of a WEDDING rings (2

pcs) weighing 3.5 grams;
That said jewelry was pawned at Mlhuiller Pawnshop, Midsalip Branch sometime
last February 03, 2012 and sad to note that said official receipt bearing OR No. 0482-
2012-00110 was lost in my possession together with my wallet within the vicinity of
B.E., it might be fallen or taken by some bad elements, and I tried to locate the same but

JULIET ASEÑAS
Affiant

Doc. No. 19
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: SSS I.D.)
I, ROSADELIMA SALON PUERTO, of legal age, Filipino, and a resident of Alta

Tierra, Tiguma, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
That I am a bona fide member of the Social Security System (SSS) bearing SSS
No. __________________ duly issued in my name;
That sad to note that said SSS I.D’s was lost in my possession together with my
wallet as enclosed on it, it might be taken by some bad elements or lost somewhere else
and I tried to locate the same but nowhere to be found;
That despite effort to locate the said receipt but the same is fruitless and I believe
it was inadvertently misplaced, hence, this affidavit;

ROSADELIMA SALON PUERTO

Affiant
SUBSCRIBED AND SWORN TO before me this 25 th day of February 2012 at

Doc. No. 19
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: GSIS POLICY)
I, VILMA PUGOY YLANAN, of legal age, Filipino, married and a resident of

Guipos, Zamboanga del Sur, after having been duly sworn to in accordance with law, do
That I am a law abiding citizen and that I am a public school teacher by

profession and presently assigned at Katipunan Elementary School, Guipos, Zamboanga
del Sur;
That I am a bonafide member of the GSIS bearing GSIS No. 006-0026-4911-7,

said policy were kept in our house for safe keeping and easy access but unfortunately,
sometime on February 11, 2006, our conjugal home was razed to fire and we left nothing
except our self; said policy were among those burned.
That despite effort to locate the same is fruitless and I believe it was burned and
cannot be retrieved;
IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of April,

VILMA PUGOY YLANAN

Affiant
SUBSCRIBED AND SWORN TO before me this 23 rd day of April 2012 at
Doc. No. 22
Page No. 5
Book No. XVII
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: ST. PETER POLICY NUMBER)
I, WENCESLAO YLANAN, of legal age, Filipino, married and a resident of

Guipos, Zamboanga del Sur, after having been duly sworn to in accordance with law, do
St. Peter Life Plan, Inc bearing LPA NO. 00596045 duly registered in my name;
That said policy were kept in our house for safe keeping and easy access but
unfortunately, sometime on February 11, 2006, our conjugal home was razed to fire and
we left nothing except our self; said policy were among those burned.
That despite effort to locate the same is fruitless and I believe it was burned and
cannot be retrieved;
IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of April,

WENCESLAO YLANAN
Affiant
SUBSCRIBED AND SWORN TO before me this 23 rd day of April 2012 at

Doc. No. 22
Page No. 5
Book No. XVII
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: AFPSLAI PASSBOOK)
I, SPO1 ROBERTO REYES SANOY, of legal age, Filipino, married and a

resident of Ozamis City, after having been duly sworn to in accordance with law, do
That I am a law abiding citizen and a Police Officer and that I am an absolute
member and depositor of AFPSLAI and as such I was being issued a PASSBOOK (RED
& BLUE) bearing Account No. __________________________;
That said passbooks were lost in my possession, it might be misplaced or lost and
I tried to locate the same but nowhere to be found;
misplaced, hence, this affidavit;

SPO1 ROBERTO REYES SANOY

Affiant

Doc. No. 20
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT OF LOSS
(ATM ONE NETWORK BANK)
I, MARITES CABARON INTE, of legal age, Filipino, married and a resident

Sta. Lucia District, Zamboanga del Sur, after having been duly sworn to in accordance
That I am a law abiding citizen;
That I am a bonafide depositor of ONE NETWORK BANK, Pagadian Branch,

bearing Account No. 05358047093, duly issued in my name;
That sad to note that said ATM was lost in my possession yesterday, I tried to
locate in my file cabinet, but the same were cannot be located, it might be misplaced or
totally lost;

MARITES CABARON INTE

Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2012

:
AFFIDAVIT of LOSS
I, ALSIMAR BARRI, of legal age, Filipino, single and a resident of Banale,

That I am a law abiding citizen and that I am a bonafide owner of a necklace

weighing 6 grams;
That said jewelry was pawned at FA Pawnshop sometime last April 9, 2012 and
sad to note that said official receipt was lost in my possession while riding passenger
motorcycle, and I tried to locate the same but nowhere to be found;
misplaced, hence, this affidavit;

ALSIMAR BARRI
Affiant

Doc. No. 20
Page No. 4
Book No. XVI
SERIES OF 2012
:
AFFIDAVIT OF LOSS
(1ST VALLEY BANK PASSBOOK)
I, SURSANITA C. MAHAWAN, of legal age, Filipino, single and a resident

Poblacion Guipos, Zamboanga del Sur, after having been duly sworn to in accordance
That I am a law abiding citizen and a government employee of the Local

Government of Guipos, Zamboanga del Sur;
That I am a bonafide member/depositor of FIRST VALLEY BANK, Dumalinao

Branch, bearing Account No. 55-02349-5, duly issued in my name;
That sad to note that said PASSBOOK was lost in my possession sometime last
week month, I tried to locate in my file cabinet, but the same were cannot be located, it
might be misplaced or totally lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of March,
SURSANITA C. MAHAWAN
Affiant
SUBSCRIBED AND SWORN TO before me this 16 th day of March 2012 at

Doc. No.
Page No.
Book No.
SERIES OF 2012

:
AFFIDAVIT OF LOSS
(ZSMIT SCHOOL LEDGER)
I, MARJUN C. DABAL, of legal age, Filipino, single and a resident Pitogo,

Zamboanga del Sur, after having been duly sworn to in accordance with law, do hereby
depose and say:
That I am a law abiding citizen and a bonafide student of ZSMIT, Pagadian City
and a First Year Bachelor in Science in Maritime Transportation (BSMT);
That as such, I am a holder/possessor of a SCHOOL LEDGER bearing Account

No. __________________;
That sad to note that said LEDGER was lost in my possession sometime last
week March 5, 2012 when my binder was lost where place the said LEDGER, I tried to
locate in my file cabinet, but the same were cannot be located, it might be misplaced or
totally lost;
MARJUN C. DABAL
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: GSIS UMID CARD)
I, LUCENA L. LONZAGA, of legal age, Filipino, married and a resident

Balongating, Guipos, Zamboanga del Sur, after having been duly sworn to in accordance
That I am a law abiding citizen; and an employee of the Municipal Government of

Guipos as LRCO1 in the Office of the Municipal Treasurer;
That as such a government employee, I am a bona fide member of the

Government Service Insurance System (GSIS) and as such, I am a holder of an UMID
CARD bearing Card No.: ______________________;
That just recently however, I discovered that said UMID CARD was lost in my
possession and I tried to retrieve in my file cabinet but unfortunately it is nowhere to be
found;
That despite effort to locate the same prove futile and useless, hence, this
affidavit;
IN WITNESS WHEREOF, I have hereunto set my hand this 29t h day of February,
LUCENA L. LONZAGA
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: Professional Driver’s License
I, JOBERT G. SANAAN, Filipino, single and a resident Balintawak, Pagadian
City, Zamboanga del Sur, after having been duly sworn to in accordance with law, do
That I am a law abiding citizen; and driver by profession;
That as such, I am a holder/possessor of a PROFESSIONAL DRIVER’S

LICENSE duly issued in my name by the Land Transportation Office bearing License
No. ___________________;
That sometime on March 11, 2012, while in the vicinity of Pitogo Municipality I
noticed that my wallet was not anymore in my possession, it might be fallen while were
busy repairing and changing tires in the said municipality, enclosed on it was my driver’s
license and some amount of cash;
affidavit;
IN WITNESS WHEREOF, I have hereunto set my hand this 12t h day of March,
JOBERT G. SANAAN
Affiant

Doc. No. 13
Page No. 3
Book No. XVII
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: ZSMIT I.D.)
I, RYAN C. JOAQUIN, of legal age, Filipino, and a resident of Paradise,

Diplahan, Zamboanga Sibugay, after having been duly sworn to in accordance with law,
That I am a law abiding citizen and a bona fide student of ZSMIT, Pagadian City
taking up Marine Engineering;
That as proof thereof, I was issued a STUDENT LEDGER bearing Ledger No.
_______________;
That sad to note that said STUDENT was lost in my possession while walking
along Napolan Road to our house, it might be fallen along the way or taken by some bad
elements or lost somewhere else and I tried to locate the same but nowhere to be found;
That despite effort to locate the same but the same is fruitless and I believe it was
inadvertently misplaced, hence, this affidavit;
IN WITNESS WHEREOF, I have hereunto set my hand this 17 th day of

February, 2012 at Pagadian City, Philippines.
RYAN C. JOAQUIN
Affiant

Doc. No. 19
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: SSS I.D.)
I, LOURDES TABAY, of legal age, Filipino, and a resident of Poblacion Tigbao,

depose and say:

That me and my husband EDGARDO TABAY SR are both bona fide member of
the Social Security System (SSS)bearing SSS Nos. __________________ and
__________________, respectively;
That sad to note that said SSS I.D’s was lost in my possession together with my
wallet as enclosed on it, it might be taken by some bad elements or lost somewhere else
and I tried to locate the same but nowhere to be found;

February, 2012 at Pagadian City, Philippines.
LOURDES TABAY
Affiant

Doc. No. 19
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
I, JULIUS CEASAR ALVIOR, of legal age, Filipino, and a resident of Pagadian

City, Zamboanga del Sur, after having been duly sworn to in accordance with law, do
That I am a law abiding citizen and that I am a subscriber of SMART

COMMUNICATION bearing SIM CARD NUMBER: 09214526924;
That sad to note that my cellular phone bearing said Sim Card Number was lost
in my possession sometime last January 23, 2012 along Balangasan Elementary School,
Pagadian City while riding my single motorcycle, and I tried to locate the same but
That despite effort to locate the said cellular phone but the same is fruitless and I
believe it was inadvertently misplaced, hence, this affidavit;
IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of February,

GEORGE HERMOSO JR.

Affiant

Doc. No. 19
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: FA PAWNSHOP RECEIPT)
I, ZAIDA ACAS, of legal age, Filipino, and a resident New Tudela, San Pedro
That I am a law abiding citizen; and I am an absolute owner of a RING weighing

2.4grams and Earrings weighing 1.6grams;
That said jewelry was pawned at FA PAWNSHOP, Pulmones Avenue Branch,

Pagadian City sometime last January 6, 2012 worth P4,500.00 and P2500.00,
respectively, and I was issued an Official Receipt bearing OR No. 816210 but
unfortunately, said receipt was lost in my possession and I tried to locate the same but
IN WITNESS WHEREOF, I have hereunto set my hand this 24 th day of January,

ZAIDA ACAS
Affiant
SUBSCRIBED AND SWORN TO before me this 24 th day of January 2012 at

Doc. No. 19
Page No. 4
Book No. XVI
SERIES OF 2012

:
AFFIDAVIT of LOSS
(Re: PAFCPIC PASSBOOK)
I, S/SGT JUNGIE R. LAZAGA, of legal age, Filipino, married and a resident

Sunrise Village, Tiguma, Pagadian City, Zamboanga del Sur, after having been duly
That I am a law abiding citizen; and a member of the Philippine Army;
That as a member of the Philippine Army, I am a bonafide member of PAFCPIC

as such, am a holder of Passbook as proof thereof bearing Account No.
____________________;
That sad to note, said passbook was lost in my possession sometime last week
while boarding a passenger vehicle bound for Zamboanga City, despite effort to locate
the said passbook but the same is fruitless and I believe it was inadvertently misplaced,
hence, this affidavit;

December, 2011 at Pagadian City, Philippines.
S/SGT. JUNGIE R. LAZAGA

Affiant
SUBSCRIBED AND SWORN TO before me this 27 th day of December 2011 at

Doc. No. 178 Atty. FERDINAND MAS PABLO

Page No. 36 NOTARY PUBLIC
Book No. XVI Until December 31, 2011
SERIES OF 2011 IBP NO. 736352; 1-7-2011
PTR NO. 1690209; 1-7-2011
Pagadian City

:
AFFIDAVIT of LOSS
I, EMBAI M. DIPATUAN, of legal age, Filipino, married and a resident Lower

Campo Islam, Labangan, Zamboanga del Sur, after having been duly sworn to in
That I am a law abiding citizen; and I am an absolute owner of Ring weighing 2.1
grams;
That said ring was pawned at FA PAWNSHOP sometime last November 17, 2011
worth P3,700.00, and I was issued an Official Receipt bearing OR No. 810804 but
unfortunately, said receipt was lost in my possession and I tried to locate the same but

EMBAI M. DIPATUAN
Affiant

Doc. No. 179

Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: ST. PETER POLICY)
I, EMELIANA BULALA, of legal age, Filipino, married and a resident

Margosatubig, Zamboanga del Sur, after having been duly sworn to in accordance with
That I am a law abiding citizen; and I am a bona fide member of St. Peter Life
Plan, Inc. and a such a holder of a Policy bearing Contract No. 00580978;
That I tried to locate said policy because the same will be used for my late brother
OSCAR SARUEDA, unfortunately, just recently, I discovered that said policy was lost in
my possession;
That despite effort to locate the said policy but the same is fruitless and I believe

EMELIANA BULALA
Affiant

Doc. No. 179

Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: ZSMIT SCHOOL LEDGER)
I, JOHN MARK M. BUHISAN, of legal age, Filipino, single and a resident Santa
Lucia District, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
That I am a bona fide student of ZSMIT, Pagadian City taking up Seafarer and as
such I was issued a school ledger as proof thereof;
That just recently, I discovered that said ledger was lost in my possession;
That despite effort to locate the said ledger but the same is fruitless and I believe
JOHN MARK M. BUHISAN

Affiant

Doc. No. 179

Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: LAND BANK PASSBOOK)
I, DIOMEDESA V. CERILLES, of legal age, Filipino, married and a resident San

Francisco District, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
That I am a bona fide depositor of Land Bank of the Philippines bearing LBP
Account Number ________________ and as such I was issued a Passbook as proof
thereof;
That just recently, said I discovered that said passbook was lost in my possession;
That despite effort to locate the said passbook but the same is fruitless and I
believe it was inadvertently misplaced, hence, this affidavit;

DIOMEDESA V. CERILLES
Affiant

Doc. No. 179

Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
I, BELENDA C. TABIOLO, of legal age, Filipino, married and a resident

Marcos Village, San Pablo, Zamboanga del Sur, after having been duly sworn to in
That I am a bona fide depositor of First Valley Bank, Dumalinao, Zamboanga del
Sur and holder/possessor of its Bank Passbook with Account No. 55-01847-0;
That just recently however, I discovered that said bank passbook was no longer in
my possession;
That diligent effort to locate my First Valley Bank Passbook the same prove
futile and useless, hence, this affidavit;
and for any legal purposes that this may serves best.
IN WITNESS WHEREOF, I have hereunto set my hand this 5t h day of December,
BELENDA C. TABIOLO
Affiant

Doc. No. 177

Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: Pawnshop Receipt)
I, MARY SUZETTE A. ARANAS, of legal age, Filipino, married and a resident

Purok Santan, San Jose District, Pagadian City, Zamboanga del Sur, after having been
duly sworn to in accordance with law, do hereby depose and say:
That I am a law abiding citizen, and;
That I happened to make a lay away a jewelry with Mlhuiller, Gaisano Branch
particularly a bracelet sometime last August 2011 and as such I was issued an official
receipt thereof which will mature on November 2011;
That sad to note, said pawnshop receipt was lost in my possession and the same
could not be located, it might be misplaced or lost somewhere else, despite effort to
locate the same prove futile and useless, hence, this affidavit;
and to support my desire to finally have the said jewelry as it is my final payment and for
any legal purposes that this may serves best.
IN WITNESS WHEREOF, I have hereunto set my hand this 19t h day of

November, 2011 at Pagadian City, Philippines.
MARY SUZETTE A. ARANAS
Affiant
SUBSCRIBED AND SWORN TO before me this 16 th day of November 2011 at

Doc. No. 178

Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: License to Operate)
I, ANSELMA CHAN, of legal age, Filipino, married and a resident Santiago

That I am the operator/manager of ZC United Pharmacy, Pagadian Branch IV,

located at F.S. Pajares Avenue, Santiago District, Pagadian City;
That as such business is a holder of a License to Operate duly issued by the

Bureau of Foods and Drugs (BFAR) bearing LTO No. RDI-RIX-DS-205 dated
November 12, 2002;
That sad to note, said license to operate was lost in my possession and the same
could not be located, it might be misplaced or lost somewhere else, despite effort to
locate the same prove futile and useless, hence, this affidavit;

ANSELMA CHAN
Affiant
Doc. No. 178

Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: FA PAWNSHOP )
I, NAIFA M. MABANG, of legal age, Filipino, married and a resident Tapodoc,

That I am a law abiding citizen; and
That I am an absolute owner of a bangles;
That sometime last September 12, 2011, said jewelry were pawned at FA
Pawnshop in the amount of P8,400.00 and as proof thereof, I was issued a Pawnshop
Receipt thereof bearing O.R. 401293;
That sad to note, said pawnshop receipt was lost in my possession it might be
misplaced or lost somewhere else, despite effort to locate the same prove futile and
useless, hence, this affidavit;
and to support my desire to redeem the same and for any legal purposes that this may
serves best.

NAIFA M. MABANG
Affiant

Doc. No. 178
Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: PRC CLAIM SLIP )
I, MARISSA SARABIA CALING, of legal age, Filipino, married and a resident

Poblacion A, Midsalip , Zamboanga del Sur, after having been duly sworn to in
That I am a professional teacher presently assigned at Midsalip National High

School and a holder and possessor of a Professional License for Teacher duly issued by
the Professional Regulation Commission bearing License No. 09151976 and as such, I
was being issued an identification card thereof;
That sometime last year as I renew the said license and as proof thereof, I was
issued a claim stub but sad to note that said claim stub was lost in my possession, the
same might be misplaced or lost;
affidavit;

MARISSA SARABIA CALING

Affiant

Doc. No. 178
Page No. 36
Book No. XVI
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: SSS I.D )
I, MELANIE C. UBAS, of legal age, Filipino, and a resident 240 Golden Heights
Subdivision, Tiguma, Pagadian City, Zamboanga del Sur, after having been duly sworn
No. ___________________;
That sad to note, sometime last March 2011 said SSS Identification Card was lost
in my possession while walking along the main road of Pagadian City proper, when I
found out that my bag were already open and my wallet were lost, enclosed on it is the
SSS ID and other important documents and some amount of cash, I honestly believe the
same were taken by some bad elements;
affidavit;
IN WITNESS WHEREOF, I have hereunto set my hand this 12t h day of October,
MELANIE C. UBAS
Affiant
SUBSCRIBED AND SWORN TO before me this 12 th day of October 2011 at

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: SSS I.D )
I, JOCELYN S. GUILLERGAN, of legal age, Filipino, and a resident Golden

Heights Subdivision, Tiguma, Pagadian City, Zamboanga del Sur, after having been duly
No. 08-0341907-6;
That sad to note, sometime last month 2011 said SSS Identification Card was lost
in my possession while riding a passenger vehicle from Down Town Pagadian to our
home, I noticed that my wallet were no longer in my possession, I honestly believe that
said wallet could not anymore be located due to the fact that I have exerted much effort to
locate but the same prove futile and useless, enclosed on said wallet were my SSS
Identification Card and some amount of Cash;
affidavit;
JOCELYN S.
GUILLERGAN
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011
:
AFFIDAVIT of LOSS
(Re: 1st Valley Bank)
I, VINCENT Q. VALDEZ, of legal age, Filipino, and a resident San Francisco

That I am an absolute owner of a SEIKO DIVER with Serial No. 370143;
That I pawned said jewelry sometime last June 22, 2011 at Mlhuiller Pawnshop,
Pulmones Avenue, Pagadian City bearing Pawnshop Receipt No. 2011-01554;
That just recently however, I discover that said receipt was lost in my possession
and I tried to retrieve in my file cabinet but unfortunately it is nowhere to be found;
affidavit;

VINCENT Q. VALDEZ
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: Military Dependent ID)
I, ZAIDA DANTE MANGAKOY, of legal age, Filipino, and a resident Sta. Lucia
That I am a holder/possessor of a Military Dependent ID bearing I.D. No.

_________________ duly issued in my name;
That sad to note, sometime last December 2010 at about 2:00 in the afternoon
while riding a passenger motorcycle from Mahayag to Molave, I noticed that my wallet
were no longer in my possession, it might be fallen while on my way and honestly
believe the same is lost or taken by some bad elements, enclosed on it were the said
MILITARY DEPENDENT I.D., 22K BRACELET, 14 PCS. 2X2 PICTURE, 1 PAIR
EARING and PHP32,000 CASH;
affidavit;

ZAIDA DANTE MANGAKOY

Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: FRANCHISE DOCUMENT)
I, RENATO M. SABADO, of legal age, Filipino, and a resident Jamisola St. Sta.
Lucia District, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
That I am an absolute holder and possessor of a MOTORIZED TRICYCLE

FRANCHISED bearing MTFRB CASE NO. PAG-2009-1267 with MOTOR CAB NO.
0235 suly issued in my name by the MOTORIZED TRICYCLE FRANCHISING AND
REGULATORY BOARD, Pagadian City;
That sad to note, just recently however, I discover that said receipt was lost in my
possession and I tried to retrieve in my file cabinet but unfortunately it is nowhere to be
found;
affidavit;

RENATO M. SABADO
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT of LOSS
I, NAUME HANDUGAN, of legal age, Filipino, and a resident San Jose District,
That I am an absolute owner of a choker weighing 2.8 grams;
That I pawned said jewelry at FA Pawnshop, Pulmones Avenue, Pagadian City

bearing Pawnshop Receipt No. 034639;
affidavit;

September, 2011 at Pagadian City, Philippines.
NAUME HANDUGAN
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: CEBUANA LHUILLER PAWNSHOP RECEIPT)
I, HOMER LAO, of legal age, Filipino, and a resident Balangasan District,

That I am an absolute owner of a WEDDING RING weighing 1.7 grams, that said
jewelry was pawned at Cebuana Lhuiller Pawnshop, Aquino Branch, Pagadian City
sometime last May 4, 2011 and will expire on September 22, 2011; as proof thereof, I
was issued a Pawned Receipt bearing O.R. ___________;
affidavit;

HOMER LAO
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT of LOSS
(Re: CEBUANA LHUILLER PAWNSHOP RECEIPT)
I, CAROLINA BAGUNDOL, of legal age, Filipino, married and a resident

Poblacion Sominot, Zamboanga del Sur, after having been duly sworn to in accordance
That I am an absolute owner of a RING WITH PEARL weighing 4.2 grams, that
said jewelry was pawned at Fely’s Pawnshop, Aquino Branch, Pagadian City sometime
last August 9, 2011 and will expire on December 9, 2011; as proof thereof, I was issued a
Pawned Receipt bearing O.R. 20215;
affidavit;

CAROLINA BAGUNDOL
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT
I, FREDDIE CODERA PUERTO, of legal age, Filipino, single and a resident

Lower Lapinig, Balingoan, Misamis Oriental, after having been duly sworn to in
That I am a bona fide member of SSS, bearing SSS No. 0810131648, holder of
RCBC ATM CARD, VOTER’S ID, B.I.R. TIN NUMBER and COMPANY ID:
That sad to note, sometime in May 26, 2011 at about 5:00 in the morning while
riding a public motorized vehicle from Down Town Pagadian to Balangasan district, I
found out that my wallet was no longer with me, it might left in the motor cab or taken by
some bad elements.
That despite efforts exerted to locate the same but prove futile and useless and I
honestly believe that the recovery of the same is very remote and impossible.
IN WITNESS WHEREOF, I have hereunto set my hand this 24 th day of August,

FREDDIE CODERA PUERTO

Affiant
SUBSCRIBED AND SWORN TO before me this 24 th day of August 2011 at

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT
I, ANISA S. MANGUMPIG, of legal age, Filipino, married and a resident

That I am the mother of NISHAHERA S. MANGUMPIG who has a bank account

with PNB Pagadian Branch bearing Account No. ______________________:
That sad to note, sometime last August 12, 2011 after transacting with the bank
while boarding my vehicle I found out that said passbook were no longer in my
possession, it might be fallen within the premises of the bank or while traveling.
That despite efforts exerted to locate the same but prove futile and useless and I
honestly believe that the recovery of the same is very remote and impossible.

ANISA S. MANGUMPIG
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT
(PNB PASSBOOK )
I, ANISA S. MANGUMPIG, of legal age, Filipino, married and a resident

That I am an absolute owner of an appliances, particularly:
ASTRON KARAOKE SHARP TV

NB 9013225 50243511
220V 60HZ 46watts 20V-L75M
That said appliances were in full operational and in good condition;
MELITON C. MABASAG
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(VETERANS BANK PASSBOOK)
I, ACE WILLIAM E. CERILLES, of legal age, Filipino, married and a resident

Dumalinao, Zamboanga del Sur, after having been duly sworn to in accordance with law,
That I am bona fide depositor of Veterans Bank bearing Account No.

_____________________ and a such, I am a holder and possessor of a Bank Passbook
as proof thereof;
That sad to note that said BANK PASSBOOK was lost in my possession, I tried
to locate in my file cabinet, but the same prove futile and useless, it might be misplaced
or totally lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd day of August,
ACE WILLIAM E. CERILLES

Affiant
SUBSCRIBED AND SWORN TO before me this 3 rd day of August 2011 at

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(ZSMIT SCHOOL LEDGER)
I, CHERRY PIE CADUNGOG, of legal age, Filipino, single and a resident

Balintawak, Aurora, Zamboanga del Sur, after having been duly sworn to in accordance
That I am a law abiding citizen and a bonafide student of ZSMIT, Pagadian City
and a First Year Bachelor in Science in Computer Science (BSCS);
That as such, I am a holder/possessor of a SCHOOL LEDGER bearing Account

No. __________________;
That sad to note that said LEDGER was lost in my possession sometime last July
21, 2011 when my binder was lost where place the said LEDGER, I tried to locate in my
file cabinet, but the same were cannot be located, it might be misplaced or totally lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 1 st day of August,

CHERRY PIE CADUN GOG
Affiant
SUBSCRIBED AND SWORN TO before me this 1 st day of August 2011 at

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(China Bank Passbook)
I, ROLDAN DAGUPAN, of legal age, Filipino, single and a resident Dumagoc,

That I am a law abiding citizen and a bonafide student of Zamboanga del Sur
Maritime Institute of Technology (ZSMIT), Pagadian City and a First Year BSMT;
That as such, I am a holder/possessor of a STUDENT LEDGER of said school;
That sad to note that said LEDGER was lost in my possession sometime last
Friday while walking from school to our boarding house, I found later upon arrival in our
boarding house the same were lost;

ROLDAN DAGUPAN
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(GSIS POLICY CONTRACT)
I, ROGELIO O. TASIN, of legal age, Filipino, married and a resident San

Pablo, Dumingag, Zamboanga del Sur, after having been duly sworn to in accordance
That I am a law abiding citizen and a government retiree formerly connected

with Department of Agriculture, Region IX;
That as such, I am a bona fide member of the Government Service Insurance

System, Xerox copy of the Policy contract hereto attached to form an integral part hereof;
That said Policy Contract was lost in my possession sometime last year when I
tried to retrieve in my file cabinets due to my retirement but unfortunately the same were
no longer there, it might have been misplaced or lost;
ROGELIO O. TASIN
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(PHILHEA LTH CARD)
I, LEONA CADUNGOG BORBON, of legal age, Filipino, and a resident of

Rizal Avenue, Sta. Lucia District, Pagadian City, Zamboanga del Sur, after having been
That I am a bonafide member of PHILHEALTH bearing PhilHealth No.

140500406948;
That unfortunately, sometime in May of 2011 my wallet were lost, it might be

fallen or taken by some bad elements, attached to said wallet were some important
documents and and my PHILHEALTH I.D. CARD;
IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day of July, 2011
LEONA CADUNGOG BORBON

Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT
(Yanmar 9.5 HP)
I, JOY R. PATIAN, of legal age, Filipino, married and a resident of Tabina,

depose and say:
That I am a law abiding citizen and the Municipal Administrator (designate) of

Tabina, Zamboanga del Sur;
That sometime on August 30, 1997, we signed an agreement with the DA, and we
are the recipient of the Department of Agriculture project (shallow tube well project) and
as such beneficiary, we are being awarded a YANMAR 9.5 HP to be used in our farm
(Barangay Patubigan Association);
That sad to note, sometime in March 2000, said engine YANMAR 9.5 HP were
taken by some bad elements in the residence of my father, the said incident were duly
reported in the Office of the Police for proper documentation, copy of the police blotter
hereto attached to form an integral part hereof;
I am executing this affidavit to attest the veracity of the foregoing facts and for
any legal intents and purposes;
JOY PATIAN
Affiant

Doc. No.
Page No.
Book No.
Series of 2011
That I am a holder and possessor of a Professional Driver’s License bearing

License No. _______________________ duly issued in my name by the Land
Transportation Office;
That unfortunately, last Friday (June 25, 2011) I found out that my wallet were no
longer attached or in my possession, it might be fallen or taken by some bad elementsm
attached on it was my driver’s license and some amount of cash and important
documents;
DANILO PAUL
Affiant

Doc. No.
Page No.
Book No.
Series of 2011

:
AFFIDAVIT OF LOSS
I, ANSELMA CHAN, of legal age, Filipino, married and a resident of F.S.

Pajares Avenue, Santiago District, Pagadian City, Zamboanga del Sur, after having been
That I am the proprietor/manager of United Pharmacy with place of business at

F.F. Pajares Avenue Pagadian City;
That in such capacity, I also a drug dealer and drug whole seller with number 283,
issued on February 3, 1986, issued by Bureau of Food And Drug (BFAD);
That just recently, I discovered that said documents were lost in my possession;
That despite diligent effort to locate said documents but the same is fruitless and I

ANSELMA CHAN
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(ZAMSURECO Receipt)
I, REY GUILLERGAN, of legal age, Filipino, and a resident of Alano Street

Street, San Francisco District, Pagadian City, Zamboanga del Sur, after having been duly
That I am a member/consumer of ZAMSURECO I bearing Account No. 50-5034-

0067;
That unfortunately, sometime last week when my wallet were lost, it might be
fallen or taken by some bad elements, attached to said wallet were some important
documents and the said ZAMSURECO I Receipt covering the meter deposit;
REY GUILLERGAN
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(GSIS E-CARD)
I, NORMA P. VILLAPLAZA, of legal age, Filipino, and a resident of Poblacion

Margosatubig, Zamboanga del Sur, after having been duly sworn to in accordance with
That I am a GSIS survivorship member bearing GSIS Pd. No. PB-235965 (s) and
a widow of the late JOE T. VILLAPLAZA;
That unfortunately, sometime in November of 2010 my wallet were lost, it might

be fallen or taken by some bad elements, attached to said wallet were some important
documents and GSIS E-CARD bearing No. ________________________;
NOR MA P. VILLAPLAZA
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
I, ALEX MIER BACOR, of legal age, Filipino, and a resident of Dablo Street,
Santiago District, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
That I am a professional driver and a holder of a plastic professional driver’s

license duly issued in my name by the Land Transportation Office bearing License No.
__________________;
That unfortunately, last Saturday (June 25. 2011) I found out that my wallet were
no longer attached or in my possession, it might be fallen or taken by some bad elements,
attached to said wallet were some important documents and my driver’s license where
my family depends for bread and butter;

ALEX MIER BACOR

Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(Passbook)
I, JULITA RUIZ ABBAS, of legal age, Filipino, and a resident of Alta Tierra
Subdivisionm Napolan, Pagadian City, Zamboanga del Sur, after having been duly sworn
That I am a law abiding citizen and a Public School Teacher by profession;
That I am a depositor of 1st Valley Bank, Pagadian City Branch bearing Account
No. ___________________, as proof thereof, I was issued a Passbook for my account;
That sad to note, said passbook was lost in my possession together with my wallet
sometime on June 14, 2011 at about 7:00 in the evening while boarding a passenger
vehicle bound to Pagadian City from Dumalinao, Zamboanga del Sur;

JULITA RUIZ ABBAS

Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(CONDUCTOR’S LICENSE)
I, GLENN P. DE LOYOLA, of legal age, Filipino, and a resident of Poblacion

B. Midsalip, Zamboanga del Sur, after having been duly sworn to in accordance with law,
That I am a conductor of Starlight Express with route Midsalip to Pagadian and

vice versa;
That I am a holder and possessor of a Conductor’s License bearing License No.

_______________________ duly issued in my name by the Land Transportation Office;
That unfortunately, last Saturday (May 14. 2011) I found out that my wallet were
no longer attached or in my possession, it might be fallen or taken by some bad elements;

GLENN P. DE LOYOLA
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(CERTIFICATE OF INSURANCE)
I, RONALD E. ROJAS, of legal age, Filipino, married and a resident of

Poblacion Pitogo, Zamboanga del Sur, after having been duly sworn to in accordance
That I am a law abiding citizen and a businessman by profession;
That I and my business partner LEOPOLDO SABSAL BAYOY are a member of

the FAMILY PROTECT MLHUILLER Philippines, an insurance company, as proof
thereof, we are a holder of a Certificate of Insurance bearing COI5005-FP NO. 053838,
053839 and 053840 in the name of LEOPOLDO SABSAL BAYOY:
That sad to note, said CERTIFICATE OF INSURANCE was lost in my

possession just recently when I noticed that said certificate were no longer in my file
cabinets, it might be misplaced during our home renovation;
IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of May, 2011
RONALD E. ROJAS
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(SSS I.D.)
I, LEANY B. CORTES, of legal age, Filipino, and a resident of Pagadian City,

depose and say:
That I am a member of the Social Security System (SSS) bearing SSS No.
________________________, as such I was issued an Identification Card:
That sad to note, said SSS IDENTIFICATION CARD was lost in my possession
when my wallet was lost while boarding a passenger vehicle bound to Pagadian City
downtown;
IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day of May, 2011
LEANY B. CORTES
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(F.A. Pawnshop Ramon Magsaysay Branch)
I, PACITA A. DELLA, of legal age, Filipino, married and a resident of Pitogo,

depose and say:
That I am an absolute owner of an earings:which was pawned sometime on

January 22, 2011 at F.A. Pawnshop, R. Magsaysay Branch, Pagadian City and a such, I
was issued an Official Receipt bearing O.R. No. 729358;
That sad to note, said Official Receipt was lost in my possession sometime in
March 2011 when my wallet was lost while boarding a passenger vehicle bound to
Pagadian City downtown;

PACITA A. DELLA
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(Philhealth I.D.)
I, ABSTENENCIO YLANAN, of legal age, Filipino, married and a resident of

That I am an absolute owner of a motor vehicle, which I purchased said vehicle

from Josephine Bonifacio and more particularly described as follows:
CR NO. _____________ MV FILE NO. ________________

Plate No. JR 3344 Chassis No. ___________________
Motor No. _______________ Make: SUZUKI
Year Model: ________ MODEL/sERIES: SHUGUN
That as such, I was issued a Certificate of registration under care of in the name of
JOSEPHINE BONIFACIO, I placed it in my cabinet for safekeeping and easy access but
unfortunately the same were lost together with the Official Receipt and Emission Test
Result;

ABSTENENCIO YLANAN
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(PHILIPPINE PASSPORT)
I, EMARITES DELA CERNA Y TIQUIEL, of legal age, Filipino, single and a

resident of Guling, Guipos, Zamboanga del Sur, after having been duly sworn to in
That I am a holder and possessor of a Philippine Passport bearing Passport No.

UU551102 which was issued to me by the Department of Foreign Affairs sometime on
February 12, 2007, and the same will expire on February 12, 2012;
That sad to note, sometime on April 8, 2011 while riding a passenger vehicle from
Pagadian City to our home, Guling, Guipos, Zamboanga del Sur, my wallet might be
fallen along the road or it might be taken by some bad elements, enclosed on said wallet
were some amount of cash, important documents and my Philippine Passport;
That I reported the incident to the Police for possible recovery and have it blotter,
copy of the Police Report is hereto attached to form an integral part hereof;
honestly believed that it was lost and the possibility to retrieve is very futile;
and for any legal purposes that this may serves best and to make known of it lost and to
make aware the proper authorities not to transact the same.
IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of April

EMARITES DELA CERNA Y TIQUIEL

Affiant

Doc. No.
Poage No.
Book No.
Series of 2011

:
AFFIDAVIT OF LOSS
(CHECKBOOK LAND BANK)
I, NARCISA CONTESTABLE, of legal age, Filipino, married and a resident of

Rizal Sominot, Zamboanga del Sur, after having been duly sworn to in accordance with
That I am a law abiding citizen; and a Barangay Treasurer of Rizal, Sominot,

Zamboanga del Sur
That as part of my job as Treasurer of our barangay, I have with me the
checkbook of the barangay covering Check Nos. from 00013682489 to 000136824__;
That sad to note, just recently, I discovered that said checks was no longer in my
file cabinet, it might be taken by some bad elements;
honestly believed that it was inadvertently misplaced;
and for any legal purposes that this may serves best and to make known of its lost to
make aware the proper authorities and the bank that the said checks would not be
transacted.
IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of April

NARCISA CONTESTABLE
Affiant

Doc. No.
Poage No.
Book No.
Series of 2011

:
AFFIDAVIT OF LOSS
(ORIGINAL OF TITLE NO. P-2,644)
I, JULIETA BONAC DE VERA, of legal age, Filipino, married and a resident

of Kauswagan, Aurora, Zamboanga del Sur, after having been duly sworn to in

That I am one of the heir of the late ESTEBAN BONAC an absolute owner of a
parcel of land located at Campo III (now Kauswagan) Aurora, Zamboanga del Sur
covered by OCT No. P-2,644 duly registered in his name, that some time last February
2011, I tend to locate said Title in my file cabinet because it will be needed for the
Subdivision survey unfortunately the same cannot be located, it might be misplaced or
lost, hence this affidavit of lost.
That despite diligent effort to locate the said certificate of title OCT No. P-2,644
but the same is fruitless and I believed it was inadvertently lost, hence, this affidavit;
and for any legal purposes that this may serves.

JULIETA BONAC DE VERA

Affiant

Doc. No.
Page No.
Book No.
SERIES OF 201

:
AFFIDAVIT OF LOSS
(DBP ATM and DRIVER’S LICENSE)
I, GLADY C. QUIRANTE, of legal age, Filipino, married and a resident of Alta

Tierra Tiguma, Pagadian City, Zamboanga del Sur, after having been duly sworn to in

That I am a bona fide depositor of DEVELOPMENT BANK OF THE
PHILIPPINES (DBP), Pagadian City Branch bearing Account No.
____________________________ and a holder of an ATM Card;
That likewise I am a holder and possessor of a Professional Driver’s License

bearing License No. _______________________ duly issued in my name by the Land
Transportation Office;
That unfortunately, last Saturday (April 9. 2011) I found out that my wallet were
no longer attached or in my possession, it might be fallen or taken by some bad elements;

GLADY C. QUIRANTE
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011

:
AFFIDAVIT OF LOSS
(Professional Driver’s License)
I, FEDERICO L. SUARIN., of legal age, Filipino, married and a resident of
That I am a holder/ possessor of a Professional Driver’s license duly issued in my

name by the Land Transportation Office bearing License No. ______________________
which will expire on ______________________;
That sad to note, just recently, I discovered that said driver’s license was lost
together with my wallet sometime last month while boarding a passenger vehicle bound
to Pagadian City proper, it might be taken by some bad elements or fallen along the road;
IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of March

FEDERICO L/ SUARIN
Affiant

Doc. No.
Poage No.
Book No.
Series of 2011

:
AFFIDAVIT OF LOSS
(Certificate of Registration LTO)
I, GLENN C. POLLESCAS, of legal age, Filipino, married and a resident of Sto.

Niño District, Pagadian City, Zamboanga del Sur, after having been duly sworn to in
That I am an absolute owner of a motor vehicle, more particularly described as

follows:
CR NO. 2511428-1 MV FILE NO. 1340-00000178598

Plate No. ULU-495 Chassis No. BBAB13-B77053
Motor No. GA13-P002125B Make: NISSAN
Year Model: 1996 Body Type: SEDAN 4-DOOR
That as such, I was issued a Certificate of registration under my name bearing CR

No. 2511428-1, I placed it in my cabinet for safekeeping and easy access but
unfortunately the same were lost
GLENN C. POLLESCAS
Affiant

Doc. No.
Page No.
Book No.
SERIES OF 2011
:
AFFIDAVIT OF LOSS
(ONB PASSBOOK)
I, HERBERT P. MACALISANG, of legal age, Filipino, married and a resident

of Poblacion Mahayag, Zamboanga del Sur, after having been duly sworn to in
That I am a law abiding citizen and a public school teacher;
That I am a bona fide depositor of ONE NETWORK BANK, Pagadian City

Branch bearing Account No. 053-51-032973;
That as such, I was issued a ONB PASSBOOK as proof there of, unfortunately,
just recently I found out that said ONE NETWORK BANK PASSBOOK were no longer
in my file cabinets, it might be misplaced or lost, as far I remember after my last
transaction with the bank in 2009, I placed the same in my file cabinet for safekeeping
and easy access;
IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of March,

HERBERT P. MACALISANG
Affiant
SUBSCRIBED AND SWORN TO before me this 23 rd day of March 2011 at

Doc. No.
Page No.
Book No.
SERIES OF 2011
:
AFFIDAVIT OF LOSS
(CELLULAR PHONE with SMART SIM)
I, ABDULMOIN SALIK, of legal age, Filipino, married and a resident of F.S.

Pajares Avenue, Santiago District, Pagadian City, Zamboanga del Sur, after having been
That I am a SMART subscriber for a quite sometime bearing SIM NO.

09086567760;
That unfortunately, sometime last February 25, 2011 while boarding a motorized
vehicle from Pagadian City Proper bound to our residence, I found out that said cellular
phone including the SMART SIM CARD were no longer in my pocket, it might be fallen
while on board or taken by some bad elements
and for any legal purposes that this may serves best and to support my desire to retain
my SMART SIM NUMBER .
IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd day of March,

ABDULMOIN SALIK
Affiant
SUBSCRIBED AND SWORN TO before me this 3 rd day of March 2011 at

Doc. No.
Page No.
Book No.
SERIES OF 2011
:
AFFIDAVIT OF LOSS
(FORM 138-A)
I, MILFRED Y. PACQUIAO, of legal age, Filipino, single and a resident of

Crossing Pitogo, Zamboanga del Sur, after having been duly sworn to in accordance with
That I am a former student of PAULINO DARI NATIONAL HIGH SCHOOL,

Sugbay Dos, Pitogo, Zamboanga del Sur, School Year 2005-2006;
That all my pertinent school documents were kept inside my file cabinets, such as
the Diploma and other school records and FORM 138-A, unfortunately, I discovered that
my FORM 138-A were no longer there, it might be misplaced or lost;
and to support my desire to have a duplicate copy thereof for me to enroll this school year
IN WITNESS WHEREOF, I have hereunto set my hand this 31st day of January,
MILFRED Y. PACQUIAO
Affiant
SUBSCRIBED AND SWORN TO before me this 31 st day of January 2011 at


Book No. XVIII Until December 31, 2011
SERIES OF 2011 IBP NO. 736552; 1-3-2011
PTR NO. 1841104; 1-3-2011
Pagadian City
:
AFFIDAVIT OF LOSS
(FORM 138-A)
I, LEILANI C, LEBRON, of legal age, Filipino, single and a resident of Purok

Dos, Poblacion Mahayag Zamboanga del Sur, after having been duly sworn to in
That I am a depositor of One Network Bank, Pagadian City Branch and a holder
of a Passbook, bearing Account No. _______________________;
That sometime last October 2010, I discovered that my passbook which was kept
in side my file cabinets were no longer there, it might be misplaced or lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of January,

LEILANI C, LEBRON
Affiant
SUBSCRIBED AND SWORN TO before me this 28 th day of January 2011 at


Book No. XVIII Until December 31, 2011
SERIES OF 2011 IBP NO. 736552; 1-3-2011
PTR NO. 1841104; 1-3-2011
Pagadian City

:
AFFIDAVIT OF LOSS
(D.T.I Certificate)
I, CONNIE L. BERNARDO MD, of legal age, Filipino, married and a resident

of 4D Cuevas Tower, Pedro Gil, Taft Avenue, Malate, Metro Manila, after having been
That I am the owner/proprietor of SAP Emission Testing Center, with principal

place of business at Land Transportation Office Compound, Tiguma District, Pagadian
City;
That aforesaid emission testing center was duly registered with the Department of
Trade and Industry, Pagadian City Office and they issued in my favor a certificate of
registration;
That just recently, I discovered that said certificate of registration was lost in my
possession;
honestly believed that it inadvertently misplaced and the possibility to retrieve the same
is very remote, hence, this affidavit;

CONNIE L. BERNARDO M.D.

Affiant

Book No. XVII Until December 31, 2010
SERIES OF 2010 IBP NO. 736352; 1-7-2010
PTR NO. 1690209; 1-7-2010
Pagadian City

:
AFFIDAVIT OF LOSS
(PAWNSHOP RECEIPT)
I, MARIAM TEMAN, of legal age, Filipino, married and a resident of San Pedro
That I am a an absolute owner of a necklace (twisted design) weighing 1.4 grams;
That said necklace were pawned in the amount of P1,400 at Cebuana Lhuiller
Pagadian Branch III, Agora Market, Pagadian City sometime last October 23, 2010, a
such, I was issued a Official Pawnshop Receipt bearing Pawn Ticket No.
50212SG008521 which will mature on November 23, 2010 and will expire on February
21, 2011, just recently, I discovered that said receipt was no longer in my file cabinet, it
might be misplaced or lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of

MARIAM TEMAN
Affiant
SUBSCRIBED AND SWORN TO before me this 23 rd day of December 2010 at

SERIES OF 2010 IBP NO. 736352; 1-7-2010
PTR NO. 1690209; 1-7-2010
Pagadian City

:
AFFIDAVIT OF LOSS
(CERTIFICATE OF TITLE NO. T-9,873)
I, NORMA BROCA REBUYON, of legal age, Filipino, married and a resident

of H. Broca Street, San Jose District, Pagadian City, Zamboanga del Sur, after having
been duly sworn to in accordance with law, do hereby depose and say:
That I am an absolute owner of a parcel of land located at Baguitan, Guipos,

Zamboanga del Sur covered by TCT No. T-9,873 duly registered in my name, that some
time last February 2010, I tend to locate said Title in my file cabinet because it will be
needed for the Subdivision survey unfortunately the same cannot be located, it might be
misplaced or lost.
That despite diligent effort to locate the said certificate of title TCT No. T-9,873
but the same is fruitless and I believed it was inadvertently lost, hence, this affidavit;

NORMA BROCA REBUYON

Affiant

SERIES OF 2010 IBP NO. 736352; 1-7-2010
PTR NO. 1690209; 1-7-2010
Pagadian City

:
AFFIDAVIT OF LOSS
(PASSBOOK)
I, JR G. RIVERA, of legal age, Filipino, married and a resident of Sambulawan,

Dinas, Zamboanga del Sur, after having been duly sworn to in accordance with law, do
That I am a bonafide depositor of ZAMSURGOFEMCO bearing Account No.

_________________________ duly issued in my name;
That a such, I was issued a Passbook bearing said account number, just recently, I
discovered that said passbook was no longer in my file cabinet, it might be misplaced or
lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 21 st day of

JR G. RIVERA
Affiant
SUBSCRIBED AND SWORN TO before me this 21st day of December 2010 at

SERIES OF 2010 IBP NO. 736352; 1-7-2010
PTR NO. 1690209; 1-7-2010
Pagadian City

:
AFFIDAVIT OF LOSS
(A.F.P. Pension I.D)
I, NORHANIE S. GUINDA., of legal age, Filipino, married and a resident of

West Migpulao, Dinas, Zamboanga del Sur, after having been duly sworn to in
That I am a bonafide member of the government project known as PANTAWID

PAMILYANG PILIPINO PROGRAM of the DSWD;
That a such, I was issued a Cash Card by the Land Bank of the Philippines (an
ATM Form) bearing Account No. _________________, just recently, I discovered that
my CASH CARD was no longer in my possession;

November 25, 2010 at Pagadian City, Philippines.
NORHANIE S. GUINDA
Affiant


SERIES OF 2010 IBP NO. 736352; 1-7-2010
PTR NO. 1690209; 1-7-2010
Pagadian City

:
AFFIDAVIT OF LOSS
(Re: Plate Number
ROMAN CATHOLIC BISHOP, represented by REV. FATHER MARIO B.

SARSABA., of legal age, Filipino, with office address at Pitogo, Zamboanga del Sur,
after having been duly sworn to in accordance with law, do hereby depose and say:
That the Roman Catholic Bishop is a registered owner of a single motorcycle

with plate number JH2636;
That just recently however, said plate number was no longer in his place;
That despite diligent effort to locate the same but the same is fruitless and now
beyond recovery;
That this affidavit is executed to attest the veracity of the foregoing statement and
for any legal purposes that this may serves best.

REV. FR. MARIO B. SARSABA

Affiant

SERIES OF 2010 IBP NO. 736352; 1-7-2010
PTR NO. 1690209; 1-7-2010
Pagadian City

Affidavit of Loss

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Affidavit of Loss

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Republic of the Philippines)

I, ARNOLFO B. COHIDOR, of legal age, Filipino, married and a resident of

That I am a bona fide grantee of Pantawid Pamilyang Pilipino Program (4 P’s);

That as such, I am a holder/possessor of a 4 P’s Identification Card;

I, EDWIN EBINA GUMAHAD, of legal age, married, Filipino, and a resident

That I am a law abiding citizen and a holder of a Professional driver’s license

IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of July,

EDWIN EBINA GUMAHAD

SUBSCRIBED AND SWORN TO before me this 25 th day of July 2012 at

I, SHESYL UKAM, of legal age, Filipino, single and a resident of Bomba,

IN WITNESS WHEREOF, I have hereunto set my hand this 17 th day of July,

SUBSCRIBED AND SWORN TO before me this 17 th day of July 2012 at

I, JESSICA PATAGOC, of legal age, Filipino, married and a resident of San

That just recently, said pawn receipt was no longer in my possession;

IN WITNESS WHEREOF, I have hereunto set my hand this 16 th day of July,

SUBSCRIBED AND SWORN TO before me this 16 th day of July 2012 at

I, PEDRITA D. AYING, of legal age, widow, Filipino, and a resident Santa

IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of

SUBSCRIBED AND SWORN TO before me this 17 th day of September 2012 at

I, JULIE AROCHA, of legal age, widow, Filipino, and a resident Balangasan

That I am a law abiding citizen and a holder of a Non-Professional driver’s

SUBSCRIBED AND SWORN TO before me this 6 th day of June 2012 at

I, BELENDA C. TABIOLO, of legal age, Filipino, married and a resident of San

That I am a law abiding citizen and that I am a bonafide depositor of FIRST

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of June,

SUBSCRIBED AND SWORN TO before me this 26 th day of June 2012 at

I, HILARION M. VILLAHERMOSA, of legal age, Filipino, single and a resident

IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of June,

SUBSCRIBED AND SWORN TO before me this 25 th day of June 2012 at

Republic of the Philippines)

I, LORENZO M. ASUELO JR., of legal age, Filipino, married and a resident of

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of June,

LORENZO M. ASUELO JR.

SUBSCRIBED AND SWORN TO before me this 18 th day of June 2012 at

Republic of the Philippines)

That I am a law abiding citizen and a former bonafide student of ZSMIT,

That as such, I am a holder/possessor of a SCHOOL IDENTIFCATION CARD

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of June,

SUBSCRIBED AND SWORN TO before me this 18 th day of June 2012 at

I, SYLVIA H. TAMALA, of legal age, Filipino, married and a resident of Tongao,

SUBSCRIBED AND SWORN TO before me this 5 th day of July 2012 at

Republic of the Philippines)

I, ABDULSATAR B. TUMOG, of legal age, Filipino, married and a resident of

That I am a law abiding citizen and that I am a holder/possessor of a Philippine

IN WITNESS WHEREOF, I have hereunto set my hand this 13 th day of June,

SUBSCRIBED AND SWORN TO before me this 13 th day of June 2012 at

Republic of the Philippines)

I, CARL LAURENCE BADIANG RUALES , of legal age, Filipino, single and a

That I am a law abiding citizen and that I am an owner of a single motorcycle

IN WITNESS WHEREOF, I have hereunto set my hand this 8 th day of June,

CARL LAURENCE BADIANG RUALES

SUBSCRIBED AND SWORN TO before me this 8 th day of June 2012 at

Republic of the Philippines)

I, MELQUIADES C. GOTONG JR., of legal age, Filipino, married and a resident

SUBSCRIBED AND SWORN TO before me this 7 th day of June 2012 at

Republic of the Philippines)

I, LUZVIMINDA D. DE LA PEÑA, of legal age, Filipino, widow and a resident of

IN WITNESS WHEREOF, I have hereunto set my hand this 7 th day of June,

SUBSCRIBED AND SWORN TO before me this 7 th day of June 2012 at

Republic of the Philippines)

I, LUZVIMINDA D. DE LA PEÑA, of legal age, Filipino, widow and a resident of

IN WITNESS WHEREOF, I have hereunto set my hand this 7 th day of June,

SUBSCRIBED AND SWORN TO before me this 7 th day of June 2012 at