Republic of the Philippines) of

Batangas )s.s.
X X

AFFIDAVIT OF LOSS

I, ANALYN MALDONADO MACATANGAY, Filipino, single, of legal age, resident of

Barangay Poblacion Malvar, Batangas, Philippines, after having been sworn by law
hereby depose and state that:

1. I am the owner of a National ID Card and UMID ID;

2. Sometime around May 18, 2024 in the Market place of Malvar around 7:00 to 7:30pm, I
lost the above ID Card under the following circumstances;

3. despite diligent efforts exerted, I could not locate or recover the National ID Card &
UMID ID, and to the best of my knowledge, the same is truly lost;

4. The said National ID Card and UMID ID have not been confiscated by any officer of the
law or the issuing agency or office due to the violation of any law, statute, order, rule, or
regulation;

5. If the lost National ID Card and UMID ID should hereafter be found or located, I
undertake to forward or surrender the same to the company where I worked for appropriate
disposal;

6. I am executing this affidavit to attest to the truth of the foregoing and to request the
issuance of a new National ID Card and UMID ID to replace the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th of May, 2024, in Malvar,
Batangas, Philippines.

ANALYN MALDONADO MACATANGAY

Affiant
Issued ID: Philhealth ID
ID No. 09-050118496-8

SUBSCRIBED AND SWORN to before me on this 20th day of May 2024, in Malvar,
Batangas Philippines.

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