REPUBLIC OF THE PHILIPPINES)

CITY OF CALAMBA ) S.S.

AFFIDAVIT OF LOSS

I, ALBERT LATOZA ROSARIO, of legal age, Filipino, married, a resident of Doña

Andeng St. Barangay Bayan Luma 2 Imus Cavite, after having been duly sworn to in accordance
with law, depose and state THAT:

1. On 31 December 2013, I was appointed as Police Officer III (SG-14) and was
issued an appointment certificate by the Philippine National Police;

2. I kept the said certificate together with my other files however, I could not
find the same as I changed residence. Despite diligent search and efforts to
locate it, I believe that they are now lost beyond recovery; and

3. As such, I am executing this affidavit to attest to the foregoing facts and to

support the application for the issuance of a new one in lieu of the one which
was lost and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of August
2023 in Calamba City, Laguna, Philippines.

ALBERT LATOZA ROSARIO

Affiant

SUBSCRIBED AND SWORN TO before me this 22nd day of August 2023 at Calamba
City, Laguna. Affiant exhibited to me his Driver’s License No. A07-03-048999.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2023.