Affiant

SUBSCRIBED AND SWORN TO before me in _________________ on

_________________ by affiant who personally appeared before me and exhibited to
me his competent evidence of identity consisting of her _________________ issued by
_________________ on _________________ valid until _________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______.

REPUBLIC OF THE PHILIPPINES)

___________________________) S.S

AFFIDAVIT OF LOSS

I, , Filipino, of legal age, with residential address at 5A02, 5th floor Corinthian
Executive Regency Condominium Ortigas Pasig, after having been duly sworn in
accordance with law, depose and state that:

1. I am a holder/owner or possessor of the following identification card, PRC ID ,

with registration date 09/13/2019 valid until 10/19/2025;

2. I have recently discovered the said identification card is irretrievably lost and can
no longer be found;

3. Despite diligent search and efforts to locate the said identification card, I could
not find the same such that I now believe that it is now lost beyond recovery;
and

4. I am executing this affidavit to attest to the truth of the foregoing for the
purpose of re-issuance of the same and for whatever legal purpose this may
serve.

IN WITNESS WHEREOF, I have set my hand this _________ day of

_____________, at ______________.