REPUBLIC OF THE PHILIPPINES)

ILOILO CITY ) S.S.

AFFIDAVIT OF LOSS

I, MAUREEN MAE MANA-AY, of legal age, single, Filipino, with residence at

PLDT Compound, Avancena St., Molo, Iloilo City after having been sworn to in
accordance with law hereby depose and say that:

1. I am a holder of a Pag-ibig Loyalty card plus with No. 1211-5747-0762

issued by the Pag-ibig in Iloilo City.

2. That on March 08, 2024, while I was on board a taxi, on my way to

Robinson’s Manila, I have m

3. My said wallet contains my Pag-ibig Loyalty card, some valuable

Identification cards, and an amount of money.

4. I took earnest efforts to locate the said wallet and even asked the assistance
of authorities, but to no avail.

5. I execute this affidavit to attest to the truthfulness and veracity of the

foregoing facts, and for the purpose of securing another UMID ID in place of
the stolen one, and for whatever purpose it may serve.

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

September 2020 in Quezon City, Philippines.

JUAN DELA CRUZ

Affiant

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

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

Notary Public

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