REPUBLIC OF THE PHILIPPINES.

)
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF EXPLANATION

I, ALFREDO A. BARUNDA, JR., of legal age, single, Filipino, and a resident of

Malibago, Bontoc, Southern Leyte, after having been duly sworn to in accordance with
the law do hereby depose and state that:

1. I am the team leader of our team assigned at

1. On May 25, 2023, me and my team was present was assigned to

2. Unfortunately, on 10 May 2020, said Payslip for the month of May was
misplaced in Sogod, Southern Leyte, where I was then assigned; and
despite repeated efforts to locate it, the same proved futile such that I now
consider it lost for all intents and purposes;

3. This declaration of loss is not intended to defraud the PAFCFIC and third
persons nor in perpetration of anything unlawful, and I hereby said
agency of any liability or responsibility arising from said loss of my
Payslip;

4. I am executing this statement to attest the truth of all the foregoing, for
loan and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 17 th day of

June 2020 at Catbalogan City.

JAMES T. BATANG
Affiant

SUBSCRIBED AND SWORN to before me this 17th day of June 2020 at

Catbalogan City, Samar, affiant exhibiting to me his AFP ID No. A20-E-235690
issued on 14 February 2020, valid until July 24, 2021.

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

1
 AFFIDAVIT OF LOSS

I, FREDERIC O. BALUDON, of legal age, married, Filipino and a resident

of Cabaruan Tabuk City, Kalinga, after having been duly sworn to in accordance
with law do hereby depose and state that:

5. Being attached to the Philippine National Police assigned at Brgy.

Guindapunan, Catbalogan City, I am also a member of the Armed
Forces and Police Savings and Loan Association, Inc. (AFPSLAI)
with corresponding passbook (green) issued in my favor;

6. Unfortunately, on February 5, 2020, said AFPSLAI passbook was

lost while I was in Batangas City, believed I t might have dropped
from my possession without my knowledge; and despite repeated
efforts to locate it, the same proved futile such that I now consider
said AFPSLAI passbook lost for all intents and purposes;

7. This declaration of loss is not intended to defraud the AFPSLAI and

third persons nor in perpetration of anything unlawful, and I hereby
absolve AFPSLAI of any liability or responsibility arising from said
loss of my passbook;

8. I am executing this statement to attest the truth of all the foregoing

and to request with AFPSLAI office for replacement or issuance of
a new passbook in lieu of the one lost and for other legal
purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 15 th

day of June 2020 at Catbalogan City.

FREDERIC O. BALUDON
Affiant

SUBSCRIBED AND SWORN to before me this 15th day of June

2020 at Catbalogan City, Samar, affiant exhibiting to me his PNP ID No.
19a160224 issued on Jan. 16, 2019, valid until Aug. 26, 2022.

2
REPUBLIC OF THE PHILIPPINES.)
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, BANJO A. CASTILLO, of legal age, single, Filipino and a resident of

Brgy. Bibiclat Aliaga, Nueva Ecija, after having been duly sworn to in accordance with
law do hereby depose and state that:

9. Being a member of the Philippine Army, I am a holder of a

military ID card which I customarily placed in my wallet;

10. Unfortunately, however, on 12 March 2020 while I was walking

inside our camp at Camp Lukban, Brgy. Maulong, Catbalogan City,
said Military ID that was then placed in my pants pocket
accidentally dropped/fell thereat without my knowledge and I
discovered such loss only when I reached my destination;

11. Notwithstanding efforts to locate my military ID card, the same

proved futile, such that, I now consider the same lost for all intents
and purposes;

12. This declaration of loss is not intended to defraud the Armed

Forces of the Philippines and third persons nor in perpetration of
anything unlawful, and I hereby absolve the AFP, its officers and
staff of any liability or responsibility arising from said loss of my
military ID card.

13. I am executing this statement to attest the truth of all the

foregoing and to request for replacement of my military ID card
and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 13 th day of

March 2020 at Catbalogan City, Samar.

BANJO A. CASTILLO
Affiant

SUBSCRIBED AND SWORN to before me this 13 th day of March 2020

at Catbalogan City, Samar, affiant exhibiting to me his PhilHealth ID No. 21-02549-
5394-0.

3
REPUBLIC OF THE PHILIPPINES.)
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, ANDRO L. GEGUERA, of legal age, single, Filipino and a resident of

Brgy. Balaring, Silay City, Negros Occidental, after having been duly sworn to in
accordance with law do hereby depose and state that:

14. Being a member of the Philippine Army, I am a holder of a

military ID card which I customarily placed in my wallet;

15. Unfortunately, however, on 24 November 2019 while I was

traveling from my assigned unit in Oras, Eastern Samar on my way
to Catbaloagn City, I accidentally dropped my wallet with said
military ID card, among others, without my knowledge and I
discovered such loss only upon reaching my destination;

16. Notwithstanding efforts to locate my wallet with said military ID

card, the same proved futile, such that, I now consider the same lost
for all intents and purposes;

17. This declaration of loss is not intended to defraud the

Armed Forces of the Philippines and third persons nor in
perpetration of anything unlawful, and I hereby absolve the
AFP, its officers and staff of any liability or responsibility
arising from said loss of my military ID card.

18. I am executing this statement to attest the truth of all the

foregoing and to request for replacement of my military ID
card and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 26 th day of

November 2019 at Catbalogan City, Samar.

ANDRO L. GEGUERA
Affiant

SUBSCRIBED AND SWORN to before me this 26 th day of November

2019 at Catbalogan City, Samar, affiant exhibiting to me his AFPS;AI ID No.
1175660.

4
REPUBLIC OF THE PHILIPPINES.)
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN…………..)

AFFIDAVIT OF LOSS

I, PACITA C. CABARLOC, of legal age, married, Filipino and a resident of

Brgy. Lokilokon Paranas, Samar, after having been duly sworn to in accordance with law
do hereby depose and state that:

1. I am a member of the Agricultural and Rural Development for

Catanduanes, Inc. (ARDCI) NGO Group, Inc.; as such I am a holder of
an ARDCI identification card ID issued in my favor;

2. Unfortunately, sometime in May 2019, I found out that said ARDCI

identification card ID was lost in my drawer at home where I usually
keep such belonging among others. Notwithstanding efforts to locate it,
the same proved futile such that I now consider it lost or all intents and
purposes;

5
 3. This declaration of loss is not intended to defraud the (ARDCI) NGO
Group, Inc. and third persons nor in perpetration of anything unlawful,
and I hereby absolve said agency;

4. I am executing this statement to attest the truth of all the foregoing and to
request for replacement of ARDCI identification card ID and for other
legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 23th day of October

2019 at Catbalogan City.

PACITA C. CABARLOC
Affiant

SUBSCRIBED AND SWORN to before me this 23 th day of October 2019 at

Catbalogan City, Samar.

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN…………..)

AFFIDAVIT OF LOSS

I, MARK JHOMAR A. RUEDA, of legal age, single, Filipino and a resident of

Brgy. Camayse, Zumarraga, Samar, after having been duly sworn to in accordance with
law do hereby depose and state that:

19. I am an active member of the Armed Forces of the Philippines; as such I

am a holder of an Armed Forces and Police Savings and Loan
Association Inc. (AFPSLAI) identification card issued in my favor;

20. Unfortunately, on 15 May 2018, I was assigned in Villareal Samar

during the barangay election; I did not notice that my wallet containing
said AFPSLAI ID slipped out of my pants pocket. Notwithstanding

6
 efforts to locate it, the same proved futile such that I now consider it lost
or all intents and purposes;

21. This declaration of loss is not intended to defraud the AFPSLAI and
third persons nor in perpetration of anything unlawful, and I hereby
absolve said agency, its officers and staff of any liability or responsibility
arising from said loss of my AFPSLAI ID;

22. I am executing this statement to attest the truth of all the foregoing and to
request for replacement of AFSPLAI ID and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 25 th day of October

2019 at Catbalogan City.

MARK JHOMAR A. RUEDA

Affiant

SUBSCRIBED AND SWORN to before me this 25 th day of October 2019 at

Catbalogan City, Samar, affiant exhibiting to me his PhilHealth ID No. 13-000108870-0.

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, JOVER L. MABAGA, of legal age, married, Filipino and a resident of Brgy.

Bayog, Motiong, Samar, after having been duly sworn to in accordance with law do
hereby depose and state that:

7
 23. Being attached to the Philippine Army assigned at 8ID, PA, Maulong,
Catbalogan City, I am also a member of the PAFCPIC with
corresponding passbook (green) issued in my favor;

24. Unfortunately, on 03 September 2019, said PAFCPIC passbook was

lost when I misplaced at my place of assignment in Calbiga, Samar, and
despite repeated efforts to locate it, the same proved futile such that I now
consider said PAFCPIC passbook lost for all intents and purposes;

25. This declaration of loss is not intended to defraud the PAFCPIC and third
persons nor in perpetration of anything unlawful, and I hereby absolve
PAFCPIC of any liability or responsibility arising from said loss of my
passbook;

26. I am executing this statement to attest the truth of all the foregoing and to
request the PAFCPIC for replacement or issuance of a new passbook in
lieu of the one lost and to withdraw my savings thereat and for other legal
purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 6 th day of

September 2019 at Catbalogan City.

JOVER L. MABAGA
Affiant

SUBSCRIBED AND SWORN to before me this 6 th day of September

2019 at Catbalogan City, Samar, affiant exhibiting to me his Military ID No.
A17-E-144399.

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, FRANCISCO YABAO DUMALAG, JR., of legal age, married, Filipino

and a resident of Calbayog City, after having been duly sworn to in accordance
with law do hereby depose and state that:

27. Being a member of the Philippine National Police (PNP)

with present assigned unit at Catbalogan City Police Station, I

8
 am a holder of a Certificate of Mandatory Training Finisher,
Appointment Order, Individual Performance Evaluation Report,
Physical Fitness Test, among others, in the course of my
profession as such;

28. Unfortunately, however, on 08 December 2014, when the strong

typhoon “Ruby” struck same parts of Samar province, and while I was
assigned at Manuevering Platoon, Bgry. Migara, Calbayog City, some of
my pertinent personal stuff including said Certificate of Mandatory
Training Finisher, were flashed out beyond recovery due to heavy rains
and strong winds that caused even our house almost half under water;

29. Notwithstanding my efforts to save my credentials and pertinent

papers, the same proved futile, such that I considered them, particularly,
the said Certificate of Mandatory Training Finisher, and other
credentials and trainings reports lost for all intents and purposes;

30. This declaration of loss is made in good faith and not

intended to defraud the government, particularly, the PNP and
third persons nor in perpetration of anything unlawful;

31. I am executing this statement to attest the truth of all the

foregoing and in support for my application for my promotion
and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 6 th day of

August 2019 at Catbalogan City.

FRANCISCO YABAO DUMALAG, JR.,

Affiant

SUBSCRIBED AND SWORN to before me this 9th day of August 2019

at Catbalogan City, affiant exhibiting to me his PNP ID No. 17F190362.

9
REPUBLIC OF THE PHILIPPINES.)
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, MARIROSE RESULTA CUSTODIO, of legal age, widowed, Filipino and a

resident of P-5 Maulong, Catbalogan City, Samar, after having been duly sworn to in
accordance with law do hereby depose and state that:

32. I am the lawful wife of the late Alexander T. Custodio who died on;
June 17, 2019 in Cagayan Valley Medical Center, Tuguegarao City,
Cagayan;

33. My deceased husband aforesaid was a retired member of the Philippine

Army; as such, he was a bonafide member of PAFCPIC with Share
Certificate issued in her favor;

34. Unfortunately, said Share Certificate of PAFCPIC of my husband was

misplace at home and notwithstanding repeated searched, the same could
no longer be found such that I considered it lost for all intents and
purposes;

35. This declaration of loss is not intended to defraud the PAFCPIC, and
third persons nor in perpetration of anything unlawful, and I hereby
absolve said agency, its officers and staff of any liability or
responsibility arising from such loss of my husband’s share certificate;

36. I am executing this statement to attest the truth of all the foregoing and in
support for my claims for death benefits/share capital due the deceased,
Alexander T. Custodio, with PAFCPIC and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 1 st day of August

2019 at Catbalogan City.

MARIROSE RESULTA CUSTODIO

Affiant

SUBSCRIBED AND SWORN to before me this 1 st day of July 2019 at Catbalogan

City, Samar, affiant exhibiting to me her Dependent’s ID No. RD12—E-82853 issued on
January 11, 2012.

REPUBLIC OF THE PHILIPPINES.)

10
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, FRANCISCO YABAO DUMALAC, JR., of legal age, married, Filipino

and a resident of Calbayog City, after having been duly sworn to in accordance
with law do hereby depose and state that:

37. Being a member of the Philippine Army with present

assigned unit at 8ID, PA, San Jose de Buan, Samar, I
regularly receive my monthly salary with corresponding pay
slip and the latest of which was for the month of April 2019;

38. Unfortunately, however, on 10 April 2019 while I was in my

assigned unit in San Jose de Buan, Samar, this city, I accidentally
dropped my pay slip without my knowledge and I discovered such
loss only lately when I am looking for it;

39. Notwithstanding efforts to locate said pay slip of April 2019, the
same proved futile, such that, I now consider the same lost for all
intents and purposes;

40. This declaration of loss of my pay slip for April 2019 is not
intended to defraud the Armed Forces of the Philippines
and third persons nor in perpetration of anything unlawful,
and I hereby absolve the AFP, its officers and staff of any
liability or responsibility arising from said loss of my pay slip;

41. I am executing this statement to attest the truth of all the

foregoing and in support for my application for loan with
AFPSLAI and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 16 th day of

May 2019 at Catbalogan City, Samar.

EDGAR S. PILAPIL
Affiant

SUBSCRIBED AND SWORN to before me this 16 th day of May 2019 at

Catbalogan City, Samar, affiant exhibiting to me his Philhealth ID No. 13-
025481935-3.

11
REPUBLIC OF THE PHILIPPINES.)
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, CASIMERO G. PEGTUAN, of legal age, widow, Filipino and with

residence at 319 Brgy. 1, Salug, Catbalogan City, after having been duly sworn to
in accordance with law do hereby depose and state that:

42. I am the lawful husband of the late Praxedes Bacay-Pegtuan who

died on April 6, 2019 in Jiabong, Samar, and who was a holder of
passbook issued by Samar Multi-Purpose Cooperative (SAMICO),
Catbalogan City;

43. Unfortunately, however, said passbook of SAMICO was missing in

our home or it might have misplaced by my late wife lately before
her death;

44. I exerted efforts to locate said passbook but to no avail such that I
now consider it lost for all intents and purposes;

45. This declaration of loss of my wife’s passbook is not

intended to defraud SAMICO and third persons nor in
perpetration of anything unlawful, and I hereby absolve
SAMICO, its officers and staff of any liability or responsibility
arising from said loss of passbook;

46. I am executing this statement to attest the truth of all the

foregoing and for death claims and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 22 nd day of

April 2019 at Catbalogan City, Samar.

CASIMERO G. PEGTUAN
Affiant

SUBSCRIBED AND SWORN to before me this 22 nd day of April 2019 at

Catbalogan City, Samar, affiant exhibiting to me his OSCA ID No.12536 issued
on Nov. 22, 2017, Catbalogan City.

12
REPUBLIC OF THE PHILIPPINES.)
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, ARIS F. GECOSALA, of legal age, married, Filipino and a resident of Brgy.

Erenas, San Jorge, Samar, after having been duly sworn to in accordance with law do
hereby depose and state that:

47. Being attached to the Philippine Army, I am also a member of the

Armed Forces of the Philippines Savings and Loan Association, Inc.
(AFPSLAI) with corresponding passbook (Red and Green) issued in my
favor;

48. Unfortunately, on 17 December 2018, said AFPSLAI passbooks (Green

and Red) were lost when I misplaced them while I was in my assigned
unit and that despite repeated efforts to locate it, the same proved futile
such that I now consider said AFPSLAI passbooks lost for all intents and
purposes;

49. This declaration of loss is not intended to defraud the AFPSLAI and
third persons nor in perpetration of anything unlawful, and I hereby
absolve said agency, its officers and staff of any liability or responsibility
arising from said loss of my passbook;

50. I am executing this statement to attest the truth of all the foregoing and
for withdrawal of my savings and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 4 th day of March

2019 at Catbalogan City.

ARIS F. GECOSALA .
Affiant

13
 SUBSCRIBED AND SWORN to before me this 7th day of February 2019 at
Catbalogan City, Samar.

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, EDGAR S. PILAPIL, of legal age, single, Filipino and a resident of

Inopacan, Leyte, after having been duly sworn to in accordance with law do
hereby depose and state that:

51. Being a member of the Philippine Army with present

assigned unit at 20IB, 8ID, PA, Las Navas, Northern Samar,
I regularly receive my monthly salary with corresponding pay
slip and and the latest of which was for the month of
February 2019;

52. Unfortunately, however, on 26 February 2019 while I was in Brgy.

Maulong, this city, I accidentally dropped my pay slip for the month
of February 2019 without my knowledge and I discovered such
loss only when I was already home;

53. Notwithstanding efforts to locate said pay slip of February 2019, the
same proved futile, such that, I now consider the same lost for all
intents and purposes;

54. This declaration of loss of my pay slip for February 2019 is

not intended to defraud the Armed Forces of the
Philippines and third persons nor in perpetration of
anything unlawful, and I hereby absolve the AFP, its officers
and staff of any liability or responsibility arising from said
loss of my pay slip;

55. I am executing this statement to attest the truth of all the

foregoing and in support for my application for loan with
AFPSLAI and for other legal purposes.

14
 IN WITNESS WHEREOF, I hereunto affix my signature this 16 th day of
May 2019 at Catbalogan City, Samar.

EDGAR S. PILAPIL
Affiant

SUBSCRIBED AND SWORN to before me this 16 th day of May 2019 at

Catbalogan City, Samar, affiant exhibiting to me his Philhealth ID No. 13-
025481935-3.

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF SAMAR……………) S.S.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, RAMON A. NUÑEZ, of legal age, married, Filipino and with residence at 352
Rizal Avenue, Catbalogan City, after having been duly sworn to in accordance with law
do hereby depose and state that:

56. I was a former member of the Philippine Army; as such I was issued a
military ID card but such was lost sometime in 2015 when my wallet
containing said military ID card, among others, slipped out of my pants’
pocket while I was riding in a motorcycle;

57. Notwithstanding my efforts to locate my wallet with said military ID

card, the same proved futile such that I considered said military ID card
lost for all intents and purposes;

58. This declaration of loss is not intended to defraud the Armed Forces of
the Philippines (AFP0 and third persons nor in perpetration of anything
unlawful, and I hereby absolve the AFP, its officers and staff of any
liability or responsibility arising from said loss of my ID card;

59. I am executing this statement to attest the truth of all the foregoing and to
support my claims for commutation and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 26 th day of

February 2019 at Catbalogan City.

RAMON A. NUÑEZ .
Affiant

SUBSCRIBED AND SWORN to before me this 26 th day of February 2019 at

Catbalogan City, Samar, affiant exhibiting to me his AFPSLAI ID No. 717874.

15
 AFFIDAVIT OF LOSS

I, PAULO CARIAS AGDA, of legal age, married, Filipino and a resident of

Tabunan, Borongan City, after having been duly sworn to in accordance with law
do hereby depose and state that:

16
 60. I am a member-beneficiary of AFPSLAI with corresponding
passbook (color red) issued in my favor;

61. Unfortunately, said AFPSLAI passbook was lost when it dropped

from my clutch bag while I was in Cagayan De Oro City, without
my knowledge;

62. Notwithstanding my efforts to locate said passbook of AFPSLAI,

the same proved futile, such that, I now consider the same lost for
all intents and purposes;

63. This declaration of loss is not intended to defraud the

AFPSLAI and third persons nor in perpetration of anything
unlawful, and I hereby absolve AFPSLAI, its officers and
staff of any liability or responsibility arising from said loss of
passbook ;

64. I am executing this statement to attest the truth of all the

foregoing and to request the AFPSLAI office for the
replacement of my red passbook in lieu of the one lost and
for loans purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 7 th day of

February 2019 at Catbalogan City, Samar.

PAULO CARIAS AGDA

Affiant

SUBSCRIBED AND SWORN to before me this 7 th day of February 2019

at Catbalogan City, Samar, affiant exhibiting to me his PhilHealth ID No. 13-
025031610-1.

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF SAMAR……………) S.S.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, REYNALDO MABALA SUMARGO, of legal age, married, Filipino and a

resident of Rizal Extension, Ormoc City, after having been duly sworn to in accordance
with law do hereby depose and state that:

17
 65. Being attached to the Philippine Army; I am also a member of the
PAFCPIC with corresponding ID card issued in my favor;

66. Unfortunately, said PAFCPIC ID card was lost when it slipped out of my
pants’ pocket without my knowledge while I was in Brgy. Maulong, this
city, and despite my efforts to locate it, the same proved futile such that I
now consider said PAFCPIC ID lost for all intents and purposes;

67. This declaration of loss is not intended to defraud the PAFCPIC and third
persons nor in perpetration of anything unlawful, and I hereby absolve
PAFCPIC of any liability or responsibility arising from said loss of my
ID card;

68. I am executing this statement to attest the truth of all the foregoing and to
request the PAFCPIC for replacement or issuance of a new ID card in
lieu of the one lost and for loan purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 1 st day of February

2019 at Catbalogan City.

REYNALDO MABALA SUMARGO .

Affiant

SUBSCRIBED AND SWORN to before me this 1 st day of February 2019 at

Catbalogan City, Samar, affiant exhibiting to me his AFP Military ID No. a16-E-105718
valid until 22 January 2019.

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

18
 I, JED GALING BROZAS, of legal age, single, Filipino and a resident of
Brgy. Catorse De Agosto, Gandara, Samar, after having been duly sworn to in
accordance with law do hereby depose and state that:

69. I am an active member of Philippine National Police with

present assignment at Gandara Police Station, Gandara,
Samar; as such, I am also a member of Air Materiel Wings
Savings and Loan Association, Inc. (AMWSLAI) with
corresponding passbook (color violet and yellow) issued in my
favor;

70. Unfortunately, on 13 November 2013, when the strong typhoon

“YOLANDA”, hit some parts of Western Samar, including our
area, said AMWSLAI passbook, along with other pertinent
papers, were destroyed and flashed away beyond recovery by
strong winds and heavy rains;

71. This declaration of loss is not intended to defraud the

AMWSLAI and third persons nor in perpetration of anything
unlawful, and I hereby absolve the AMWSLAI its officers and
staff of any liability or responsibility arising from such loss of
passbook;

72. I am executing this statement to attest the truth of all the

foregoing and for withdrawal of overpayment and capital
contribution and other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 18 th day of

January 2019 at Catbalogan City, Samar.

JED GALING BROZAS

Affiant

SUBSCRIBED AND SWORN to before me this 18th day of January

2019 at Catbalogan City, Samar, affiant exhibiting to me his PNP ID No.
18D030075 valid until Sept. 19, 2021.

AFFIDAVIT OF LOSS

I, ANTONIO B. GLOBIO, JR., of legal age, single, Filipino and a resident of

Brgy. San Rafael, Hinabangan, Samar, after having been duly sworn to in accordance
with law do hereby depose and state that:

19
 73. Being attached to the Philippine Army assigned at 63IB, 8ID, PA, Brgy.
Erenas, San Jorge, Samar, I am also a member of the PAFCPIC with
corresponding ID card issued in my favor;

74. Unfortunately, said PAFCPIC ID card was lost when it slipped out of my
pants’ pocket without my knowledge while I was in Brgy. Maulong, this
city, and despite my efforts to locate it, the same proved futile such that I
now consider said PAFCPIC ID lost for all intents and purposes;

75. This declaration of loss is not intended to defraud the PAFCPIC and third
persons nor in perpetration of anything unlawful, and I hereby absolve
PAFCPIC of any liability or responsibility arising from said loss of my
ID card;

76. I am executing this statement to attest the truth of all the foregoing and to
request the PAFCPIC for replacement or issuance of a new ID card in
lieu of the one lost and for loan purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 7 th day of

December 2018 at Catbalogan City.

ANTONIO B. GLOBIO, JR.

Affiant

SUBSCRIBED AND SWORN to before me this 7 th day of December 2018

at Catbalogan City, Samar, affiant exhibiting to me his BIR TIN 409-860-075-
000.

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, NOE BALAGAPO RAMA, JR., of legal age, married, Filipino and a

resident of Sulat Eastern Samar, after having been duly sworn to in accordance
with law do hereby depose and state that:

77. I am a member-beneficiary of AFPSLAI with corresponding

passbook (color green) issued in my favor;

20
 78. Unfortunately, said AFPSLAI passbook was lost when it dropped
from my clutch bag while I was riding in a passenger bus on
November 1, 2018 without my knowledge;

79. Notwithstanding my efforts to locate said green passbook of

AFPSLAI, the same proved futile, such that, I now consider the
same lost for all intents and purposes;

80. This declaration of loss is not intended to defraud the

AFPSLAI and third persons nor in perpetration of anything
unlawful, and I hereby absolve AFPSLAI, its officers and
staff of any liability or responsibility arising from said loss of
passbook ;

81. I am executing this statement to attest the truth of all the

foregoing and to request the AFPSLAI office for the
replacement of my green passbook in lieu of the one lost
and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 6 th day of

November 2018 at Catbalogan City, Samar.

NOE BALAGAPO RAMA, JR.

Affiant

SUBSCRIBED AND SWORN to before me this 22 nd day of October 2018

at Catbalogan City, Samar, affiant exhibiting to me his PhilHealth ID No. 13-
000111207-5.

AFFIDAVIT OF LOSS

I, PEDRO INOLPE OBLINO, JR., of legal age, married, Filipino and a resident
of Brgy. Mercedes, Catbalogan City, after having been duly sworn to in accordance with
law do hereby depose and state that:

82. Being attached to the Philippine Army assigned at Midsayap, Cotabato,

I am a member of the PAFCPIC with corresponding ID card issued in
my favor;

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 83. Unfortunately, said PAFCPIC ID card was among those important items
that was destroyed and burnt beyond recovery when big fire gutted some
houses including our house in Pier 1, this city, on May 8, 2018

84. This declaration of loss is not intended to defraud the PAFCPIC and
third persons nor in perpetration of anything unlawful, and I hereby
absolve PAFCPIC of any liability or responsibility arising from said loss
or destroyed ID card;

85. I am executing this statement to attest the truth of all the foregoing and to
request the PAFCPIC for replacement or issuance of a new ID card in
lieu of the one lost.

IN WITNESS WHEREOF, I hereunto affix my signature this 24 th day of

October 2018 at Catbalogan City.

PEDRO INOLPE OBLINO, JR.

Affiant

SUBSCRIBED AND SWORN to before me this 24 th day of October

2018 at Catbalogan City, Samar, affiant exhibiting to me his Military ID No.
A16-E-106006 Oct. 31, 2018.

AFFIDAVIT OF LOSS

I, , of legal age, married, Filipino and with residence at Capt. Vilbar St.,
Hilongos, Leyte, after having been duly sworn to in accordance with law do
hereby depose and state that:

86. I am a member-beneficiary of AFPSLAI with corresponding

passbook (color green) issued in my favor;

87. Unfortunately, said AFPSLAI passbook was lost or I might have

misplaced it somewhere at my assigned unit and that

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 notwithstanding my efforts to locate it, the same proved futile, such
that, I now consider said AFPSLAI passbook lost for all intents and
purposes;

88. This declaration of loss is not intended to defraud the

AFPSLAI and third persons nor in perpetration of anything
unlawful, and I hereby absolve AFPSLAI, its officers and
staff of any liability or responsibility arising from said loss of
passbook ;

89. I am executing this statement to attest the truth of all the

foregoing and to request the AFPSLAI office for the
replacement of my green passbook and ID card in lieu of
the one lost and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 22 nd day of

October 2018 at Catbalogan City, Samar.

ARTURO JR. V. RUBIO

Affiant

SUBSCRIBED AND SWORN to before me this 22 nd day of October 2018

at Catbalogan City, Samar, affiant exhibiting to me his Professional DL No. H02-
06-000647 valid until 2022-02-12.

90. passbook and my ID card were among those important items that were
washed out during the strong typhoon “Ruby” on 08 December 2014 and
despite my efforts to save and retrieved those items particularly, said
AFPSLAI red passbook and ID card, the same proved futile, such that, I
now consider them lost for all intents and purposes;

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

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 AFFIDAVIT OF LOSS

I, CHRISTIAN A. CUAYCONG of legal age, married, Filipino and with

residence at Brgy. 4, Pier 2, Allen Avenue, Catbalogan City, after having been
duly sworn to in accordance with law do hereby depose and state that:

91. Being attached to the Philippine National Police, assigned at

Jiabong, Samar, Municipal Police Station, I am also a member of
the AFPMBAI with Policy Contract issued in my favor;

92. Unfortunately, on 20 June 2014, while I was in Basey, Samar, my

brown envelope containing said AFPmbai Policy Contract,
among others, was lost from my possession without my
knowledge; and such was discovered only as I arrived in my
destination;

93. Earnest search for said policy contract notwithstanding, the same
proved futile such that I now consider said policy contract lost for
all intents and purposes;

94. The fact of loss is not intended to defraud the AFPMBAI and
third persons nor in perpetration of anything unlawful, and I
hereby absolve AFPMBAI of any liability or responsibility arising
from such loss;

95. I am executing this statement to attest the truth of all the

foregoing and for claims (Bonus) purposes. .

IN WITNESS WHEREOF, I hereunto affix my signature this 13 th day of

July 2017 at Catbalogan City.

CHRISTIAN A. CUAYCONG
Affiant

SUBSCRIBED AND SWORN to before me this13th day of July 2017 at

Catbalogan City, Samar, affiant exhibiting to me his PNP Non-Commissioned
Officer ID No. 15k230315 issued on November 23, 2015 and valid until June 24,
2018.

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REPUBLIC OF THE PHILIPPINES.)
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..… )

AFFIDAVIT OF LOSS

I, SUSITA A. CULMINAS, of legal age, married, Filipino and a resident

of Tarangnan, Samar, after having been duly sworn to in accordance with law do
hereby depose and state that:

96. Being a member of the Philippine Army, I am also a member of

the PAFCPIC with Green passbook issued in my favor;

97. Unfortunately, however, on September 19, 2015, while I was in

Catbalogan City and thereat riding in pedicab, I did not notice that
said Passbook slipped out of my bag and I discovered such loss
only upon reaching my destination;

98. I exerted efforts to locate said PAFCPIC passbook buti to no

avail, such that I now consider it lost for all intents and purposes;

99. The fact of loss is not intended to defraud the PAFCPIC and
third persons nor in perpetration of anything unlawful, and I
hereby absolve PAFCPIC of any liability or responsibility arising
from said loss of passbook;

100. I am executing this statement to attest the truth of all the

foregoing and to request the PAFCPIC office for the replacement
of said passbook and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 13 th day of

April 2016 at Catbalogan City.

SUSITA A. CULMINAS
Affiant

SUBSCRIBED AND SWORN to before me this 13th day of April 2016 at

Catbalogan City, Samar, affiant exhibiting to me his UMID ID CRN 006-0064-
3370-1.

REPUBLIC OF THE PHILIPPINES.)

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PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..… )

AFFIDAVIT OF LOSS

I, MA. AIDA D. ARTECHE, of legal age, married, Filipino and with residence
at Pogi Avenue, Brgy. Maulong, Catbalogan City, Samar, after having been duly sworn to
in accordance with law do hereby depose and state that:

101. I am a dependent of an AFP retired enlisted personnel; as

such, I am a member of the Armed Forces and Police Savings and Loan
Association, Inc. (AFPSLAI) with a Green passbook and ID card issued
in my favor;

102. Unfortunately, however, sometime in the first week of

October 2015, I discovered that said Green Passbook and ID card were no
longer in my wallet then commingled with a little money and other
identification cards; and despite my earnest and successive efforts to
locate such passbook as it might had been only misplaced at home, the
same proved futile, such that with the lapse of reasonable period of time,
I now consider said passbook lost for all intents and purposes;

103. The fact of loss is not intended to defraud the AFPSLAI and
third persons nor in perpetration of anything unlawful, and I hereby
absolve AFPSLAI, its officers and staff of any liability or responsibility
arising from said loss of passbook;

104. I am executing this statement to attest the truth of all the

foregoing and to request the AFPSLAI office for the replacement of my
green passbook and ID card and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 4 th day of

January 2016 at Catbalogan City, Samar.

MA. AIDA D. ARTECHE

Affiant

SUBSCRIBED AND SWORN to before me this 4 th day of January 2016 at

Catbalogan City, Samar, affiant exhibiting to me her AFP Retired Enlisted Personnel’s
Dependent ID No. RDIS-E-110465 issued on 27 July 2015.

REPUBLIC OF THE PHILIPPINES.)

26
PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..… )

AFFIDAVIT OF LOSS

I, PFC ROGELIO L ALDE 810356 (Inf), PA, of legal age, married,

Filipino and a resident of Brgy. 6, Balangiga, Eastern Samar, after having been
duly sworn to in accordance with law do hereby depose and state that:

105. Being a member of the Philippine Army, I was issued the

corresponding military ID;

106. Unfortunately, however, on 03 November 2015, at about 10:00

o’clock, as I was on my way to Balangiga, Samar, on board a passenger
bus, I noticed that my said ID contained in my wallet along with other
IDs and a little money could no longer be found; and despite my earnest
and repeated efforts retrieve it, the same proved futile, such that I now
consider said military ID lost for all intents and purposes;

107. The fact of loss is not intended to defraud the Philippine Army
and third persons nor in perpetration of anything unlawful, and I hereby
absolve the Philippine Army of any liability or responsibility arising
from said loss of ID;

108. I am executing this statement to attest the truth of all the foregoing
and to request the Philippine Army for the replacement of the lost
military ID in lieu of the one lost.

IN WITNESS WHEREOF, I hereunto affix my signature this 21 st day of

December 2015 at Catbalogan City.

PFC ROGELIO L ALDE 810356 (Inf), PA

Affiant

SUBSCRIBED AND SWORN to before me this 21 ST day of December

2015 at Catbalogan City, Samar, affiant exhibiting to me his PAFCPIC ID
Member No. 108373.

27
REPUBLIC OF THE PHILIPPINES)

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, PFC FILOMINO O. LOPIDO, of legal age, single, Filipino and a

resident of Brgy. Abuyugon, Burauen Leyte, after having been duly sworn to in
accordance with law do hereby depose and state that:

109. Being attached to the Philippine Army assigned at 78IB,

8ID, PA, at Brgy. Calapi, Motiong, Samar, I am member of the
PAFCPIC with a Green passbook and ID card issued in my favor;

110. Unfortunately, said PAFCPIC Green Passbook and my

corresponding ID card were among those important items that
were washed out during the supper typhoon “Yolanda” on 08
November 2013 and despite my efforts to save and retrieved those
items particularly, said PAFCPIC Green passbook and ID card,
the same proved futile, such that, I now consider them lost for all
intents and purposes;

111. The fact of loss is not intended to defraud the PAFCPIC

and third persons nor in perpetration of anything unlawful, and I
hereby absolve PAFCPIC of any liability or responsibility arising
from said passbook and ID card loss;

112. I am executing this statement to attest the truth of all the

foregoing and to request the PAFCPIC to renew my ID and to
issue me a new passbook in lieu of the one lost.

IN WITNESS WHEREOF, I hereunto affix my signature this 17 th day of

December 2014 at Catbalogan City.

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 PFC FILOMINO O. LOPIDO
Affiant

SUBSCRIBED AND SWORN to before me this 17 th day of December

2014 at Catbalogan City, Samar, affiant exhibiting to me his TIN 298-470-348.

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SAMAR…………..) S.S.
CITY OF CATBALOGAN………….)

AFFIDAVIT OF LOSS

I, MATEO MABAG PABUNAN, of legal age, single, Filipino and a resident of

Purok 4, Brgy. Maulong, Catbalogan City, after having been duly sworn to in accordance
with law do hereby depose and state that:

113. I am at present the Principal I at Old Mahayag Elementary School, Brgy.

Old Mahayag, Catbalogan City;

114. However, prior to my aforesaid position, I was slated to be assigned as

Principal I at Pupua Elementary School, this city, upon retirement of its head
teacher last 01 July 2012 per assurances of the City Division Superintendent;
and certain then of my assignment thereat, I went to said school the following
week and introduced minor improvements on the principal’s office and with its
completion, I subsequently brought my office table and pertinent documents
thereat;

115. From the period September to October 2012, I conducted meetings with the
teachers of said school and re-echoed the matters taken during the meetings and
conferences I previously attended;

116. Unfortunately, on the evening of 04 November 2012, a Sunday, a resident of

Brgy. Pupua, Catbalogan City, texted me that a certain Biboy Mariano forcibly
entered my supposed office and without my consent at the instance of Juliet C.
Ignacio, the newly-assigned principal thereat; thusly, I lost the once promised
position to her;

117. The following day, Monday, 05 November 2012, I arrived in said school at
about 6:30 in the morning, to confirm the unlawful entry, and indeed I found
out, to my utter dismay and surprise, that the door padlock was replaced by a
new one, my office table was taken outside and the folder containing official
receipts of expenses for the materials for San Roque Elementary School,
Catbalogan City, which were intended for liquidation of September and October
2012 MOOE, was no longer in its place;

118. Earnest search for said receipts notwithstanding and the time that elapsed, the
same proved futile such that I now consider said receipts lost for all intents and
purposes;

119. The fact of loss is not intended to defraud the City School Division, DEPED
and third persons nor in perpetration of anything unlawful, and I hereby absolve
said entities of any liability or responsibility arising from said loss of receipts;

29
 120. I am executing this statement to attest the truth of all the foregoing and for
legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 20 th day of

December 2012 at Catbalogan City.

MATEO MABAG PABUNAN

Affiant

SUBSCRIBED AND SWORN to before me this 20 th day of December 2012 at

Catbalogan City, Samar, affiant exhibiting to me his Professional Identification Card
No. 0156564 valid until 15 June 2014.

REPUBLIC OF THE PHILIPPINES.)

PROVINCE OF SAMAR……………) SS.
CITY OF CATBALOGAN………..…)

AFFIDAVIT OF LOSS

I, SSg ROY PLACIENTE IRENE 790350 (Inf) PA, of legal age,

married, Filipino and a resident of Talalora, Samar, after having been duly sworn
to in accordance with law do hereby depose and state that:

121. Being attached to the Philippine Army assigned at 87IB,

8ID, PA, assigned at Brgy. Calapi, Motiong, Samar, I am member
of the AFPSLAI with a red passbook 002 account issued in my
favor;

122. Unfortunately, in the second week of October 2012, at

about 1:00 o’clock in the afternoon, while I was in Catbalogan
City with my loan documents, my brown envelope containing
said AFPSLAI passbook, among others, was lost from my
possession without my knowledge; and such was discovered only
as I arrived in my destination;

123. Earnest search for said passbook notwithstanding, the same

proved futile such that I now consider said passbook lost for all
intents and purposes;

124. The fact of loss is not intended to defraud the AFPSLAI

and third persons nor in perpetration of anything unlawful, and I
hereby absolve AFPSLAI of any liability or responsibility arising
from said passbook loss;

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 125. I am executing this statement to attest the truth of all the
foregoing and to request the AFPSLAI to issue me a new
passbook in lieu of the one lost.

IN WITNESS WHEREOF, I hereunto affix my signature this 31 st day of

October l 2012 at Catbalogan City.

SSg ROY PLACIENTE IRENE 790350 (Inf) PA

Affiant

SUBSCRIBED AND SWORN to before me this 31 st day of October 2012

at Catbalogan City, Samar, affiant exhibiting to me his AFP Enlisted Personnel
ID No. A12-E-000425.

126.

AFFIDAVIT

I, ALMERA C. BULAN, of legal age, single, Filipino and a resident of

Brgy. Socorro, Catbalogan City, after having been duly sworn to in accordance
with law do hereby depose and state that:

1. I am the common-law wife of Gerry V. Dillague, of legal age

and a resident of Brgy. Socorro, Catbalogan City;

2. Out of our union, we were blessed with a daughter, our eldest,

named Angela B. Dillague, born on 16 June 2011 at the Samar
Provincial Hospital, Catbalogan City;

3. The birth of said daughter was timely registered with the

Office of the Civil Registrar, Catbalogan City, but an
authenticated copy thereof has yet to be issued by the National
Statistics Office, hence, we cannot submit the same this time
to the Parish of St. Batholomew, Catbalogan City, for her
baptism;

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 4. We nevertheless affirm and confirm that said daughter is ours
and that we undertake to legally marry each other at soonest
possible time;

5. I am executing this statement to attest the truth of all the

foregoing and to facilitate the baptism of our daughter Angela
B. Dillague with the Parish of St. Bartholomew, Catbalogan
City.

IN WITNESS WHEREOF, I hereunto affix my signature this 23rd day of

December 2011 at Catbalogan City.

ALMERA C. BULAN
Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of December

2011 at Catbalogan City, Samar.

32
 1. I am a holder of a professional driver’s license issued by the
Land Transportation Office (LTO), Catblaogan City, sometime
last March 2010 which I keep in my wallet and commingled
with other IDs and a little money;;

2. Unfortunately, however, on 25 January 2011, at about 2:30

o’clock in the afternoon, at Sitio Caipilan, San Andres,
Villareal, Samar, while in the discharge of my duties as
SAMELCO II Barangay Power Association (BAPA) meter
reader/bill collector, I rode a passenger motorcycle (locally
known as “habal-habal”, on our way to a nearby dock where
our contracted motor banca was waiting for, when five (5)
unidentified armed persons robbed my collections in the sum
of P30,000.00, more or less, at gun point, including the
different bills and my wallet containing, among others, my
driver’s license;

3. I reported the robbery-hold-up incident to the Villareal

Municipal Police Station, PNP. Villareal, Samar, but under
date my wallet containing said driver’s license could no longer
be found, hence I now consider said driver’s license lost for
all intents and purposes; and which fact is not intended to
defraud the LTO and third persons nor in perpetration of
anything unlawful;

4. I am executing this statement to attest the truth of all the

foregoing and for a replacement of such lost driver’s license
with the LTO, Catbalogan City.

IN WITNESS WHEREOF, I hereunto affix my signature this 31st day of

January 2011 at Catbalogan City.

ARTURO T. TINGZON, JR.

Affiant

SUBSCRIBED AND SWORN to before me this 31 st day of January 2011,

affiant exhibiting to me his SAMELCO II Employee ID No. 089, TIN ID No.
937-593-083.

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