Republic of the Philippines)

Malolos City, Bulacan )S.S.

AFFIDAVIT OF LOSS

I, RODNEY R. MORENO, of legal age, married, Filipino and

presently residing at Pideg, Lubao, La Union, after having been duly sworn
to in accordance with law do hereby deposes and states, that:

1. I am a holder of the following Identification Cards, thus:

a. Unified Multi-Purpose Identification Card

b. LTO Driver’s License Card
c. Voter’s ID

2. On October 12, 2019 around 10:00PM while upon alighting from a

tricycle I rode on my way back home, I noticed that my wallet
containing some cash and the said subject identifications cards
were missing;

1. I exerted diligent effort to locate my said wallet containing the

Identification Cards but all efforts are in vain; and

3. I executed this affidavit to attest to the truth of the foregoing facts

and for all legal intents and purposes it may serve.

Malolos City, Bulacan, October 18, 2019.

RODNEY R. MORENO
Affiant

SUBSCRIBED AND SWORN TO before me this day 18th day of

Ocotber 2019 at Malolos City, Bulacan, Philippines. Affiant exhibited to me
his Company ID No. 9416.

Doc. No.473;
Page No. 96 ;
Book No. XIII;
Series of 2019.