AFFIDAVIT OF LOSS

I, DIONESA GADAYAN REGIS, of legal age, Filipino citizen, and resident of Barangay Bulihan
Malvar, Batangas Philippines, after being duly sworn by law, hereby depose and state under
oath:

1. That I am the lawful owner/holder of the Patawid Identification Card from the 4Ps Office;

2. That the lost ID was in my possession and custody, and I have exercised due care and
diligence to keep it safe and secure;

3. I have made a diligent search and inquiry to locate the lost ID but to no avail. It is
irretrievably lost and cannot be recovered.

4. That the loss of the said ID was not due to any negligence, willful act, or omission on my part;

5. I am executing this Affidavit of Loss to attest to the truth of the foregoing facts and to apply
for the issuance of a new/replacement ID.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th of March, 2024, in Malvar,
Batangas, Philippines.

DIONESA GADAYAN REGIS

Affiant

SUBSCRIBED AND SWORN to before me this 11th day of March 2024, in Malvar, Batangas
Philippines, affiant exhibiting competent evidence of identity through National Identification
Card with ID number: 6415-7845-9763-1251, issued on March 2, 2022.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2024.