REPUBLIC OF THE PHILIPPINES )

AFFIDAVIT OF LOSS

I, SORIANO, single, Filipino, of legal age, and with residence and postal address at #33
City, after being duly sworn to in accordance with law, hereby depose and state:

1. That I am a holder of the following identification cards which I am keeping in my wallet

together with other important documents:

ATM CARD
PROFESSIONAL DRIVER’S LICENSE ID HEALTH CARD
PAG-IBIG ID

2. That said Identification Cards and ATM Card were lost in my possession as I might have
misplaced it somewhere or could have fallen off unnoticed;

3. That all efforts were exerted to locate the same but proved to be futile;

4. That I executed this Affidavit in order to attest under oath the facts surrounding the loss
of the above-mentioned identification cards and ATM Card and to request the issuing agencies
to issue a new one in lieu thereof. FURTHER: That this Sworn Statement was executed not for
purposes of fraud or deceit.

IN WITNESS WHEREOF, I have hereunto set my hand this day of 2024 at Philippines.

SORIANO
Affiant

SUBSCRIBED AND SWORN to before me in San a this 26 th day of 2024 by . SORIANO, who
has satisfactorily proven to me his identity through his COMPANY ID, that he is the same person
who personally signed before me the foregoing affidavit of loss and acknowledged that he
executed the same freely and voluntarily.