Republic of the Philippines

Province of Isabela
Municipality of Tumauini

AFFIDAVIT OF LOSS OF FIREARM

I, PMSg Ryan P. Binalay, of legal age, married, residing at Purok 5, Brgy. Balug,
Tumauini, Isabela, after being sworn in accordance with law, depose and say:

1. I am the true and licensed owner of one (1) firearm, which is particularly described
as:

Make:
Caliber:
Kind:
Serial No.:

A copy of my Firearm License Card is hereto attached as Annex “A”;

2. That on _____(date)_____, I was inspecting my personal belongings and was

surprised to find that the said firearm was missing from its case;

3. That despite diligent search and efforts to locate the abovementioned firearm, I could
no longer find the same, such that I now believe that it is lost beyond recovery;

4. That I certify and confirm that the said firearm was neither confiscated nor
relinquished in favor of, any government entity, agency, or authority; and

5. That I am executing this Affidavit of Loss to attest to the truth of the foregoing and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 31 st day of August, 2023, in
the Municipality of Tumauini, Province of Isabela, Philippines.

RYAN P. BINALAY
(Signature of affiant)

SUBSCRIBED AND SWORN TO before me this 2nd day of October 2023 in Tumauini,
Isabela, affiant exhibiting to me his ______________ ID No. ___________ issued at
____________ on October 2, 2023.
Doc. No. ____
Page No. ____
Book No. ____
Series of 2023.