REPUBLIC OF THE PHILIPPINES)

Caloocan City ) S.S.

AFFIDAVIT OF LOSS

I, _____________________________, of legal age, single, Filipino, and a

resident of _________________________________ after having been sworn to in
accordance with law hereby depose and say that:

1. I am a holder of a Voter’s ID issued by the Commission on Elections.

2. Sometime September 2020, I was going through my stuff and found out
that my Voter’s ID was missing and cano no longer be found despite
diligent efforts to locate the same.

3. I execute this affidavit to attest to the truthfulness of the foregoing

information, and to secure another Voter’s ID at COMELEC, and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of

December 2020 in Caloocan City.

_______________________
_________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of December 2020

in Caloocan City. Affiant exhibited to me his competent evidence of identity as
__________________.

Doc. No____;
Page No. ___;
Book No. ___;
Series of 2020.