Republic of the Philippines.

)
Province of Pangasinan ) S.S.
City of Urdaneta )

AFFIDAVIT OF LOSS

I, REGGIE BOLANDRES CRUZ, of legal age and a resident of 144

Sapang, Sta. Barabara, Pangasinan, after having been sworn in accordance
with law do hereby depose and state that:

1. I am the owner of several government-issued ID cards namely

UMID and Pag-IBIG ID;

2. I am also the owner of a Security License card issued by

Stargold Security Training Center Corporation;

3. I used to be employed in a freight and trucking company;

4. The above-mentioned ID cards were kept inside my wallet

and during one of my trips, I noticed that my wallet could no
longer be found and believed to have been misplaced;

5. Despite diligent search and efforts to locate the said ID cards,

I could not find them such that I now believe that they are
now lost beyond recovery;

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

truth of the foregoing and to support my application for the
issuance of a new UMID, Pag-IBIG and Security License
cards, in lieu of the ones that were lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ___

day of March 2023 at Urdaneta City, Pangasinan.

REGGIE BOLANDRES CRUZ

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of March

2023 at Urdaneta City, Pangasinan by the affiant known to me to be the
same person who executed the foregoing instrument, and who exhibited to
me a government-issued identification card with the following details:
PhilHealth ID with card no. 05-025461839-7.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No.___;
Page No.___;
Book No.___;
Series of 2023.