Republic of the Philippines) City of Mandaluyong ) S.S.

X- - - - - - - - - - - - - - - - - - - - -X AFFIDAVIT OF TWO DISINTERESTED PERSONS We, __________________________________, __________________________ Filipino, of legal age, and ith !esidence and postal add!ess at ___________________________________ and _________________________________ afte! ha"ing been duly s o!n to in acco!dance ith the la , do he!eby depose and state# $. %hat e &no AGERICO AMAGNA III, of legal age, Retired Officer of the Armed Forces of the Philippi es and ith !esidence and postal add!ess at ! it "#$% GA To&er $ '() EDSA* M+ d+l,-o . Cit-/ '. %hat e a!e ________________________________________________________ (. %hat on _________________________________ the!e as an incident !epo!ted to us that MR/ AGERICO AMAGNA III lost his se!"ice pistol due to the c!i)e of theft. *ased on the incident !epo!t, that day he pa!&ed, loc&ed, and left unattended his "ehicle desc!ibed as colo! hite Mitsubishi +(,, -e!.a -an bea!ing plate /o. 010 (23 at the *ac& of 45 %o e! $, Sie!!a Mad!e st!eet, Mala)ig, Mandaluyong City. 1o e"e!, hen !etu!n bac& to he!e his "ehicle pa!&ed at about 3#,, PM of the sa)e date, he noticed the !ight side passenge! indo of his ca! opened and seen the!ein as sc!atches, and unfo!tunately, he disco"e!ed his colo! blue hand bag co t+i i . his colt %0 c+li1er of fire +rm &ith seri+l o/ "20%(#0 and othe! i)po!tant ite)s and docu)ents placed inside his ca! e!e al!eady )issing and no he!e to be found. 6. %hat e he!eby state unde! oath that the abo"e)entioned state)ent the incident !epo!t as appea!ing on ou! !eco!ds. as based on

2. %hat e a!e e7ecuting this affida"it to suppo!t his application fo! !eti!e)ent as such is needed fo! the p!ocessing of the sa)e. 8. %hat e a!e e7ecuting this affida"it to attest to the t!uth of the fo!egoing state)ents, and fo! hate"e! legal intents and pu!poses it )ay dee) se!"e. IN WITNESS W3EREOF, e ha"e he!eunto set )y hand this ___ day of

____________, ',$$ at the City of Mandaluyong, Philippines.

____________________________ Affi+ t ID No.__________________

____________________________ Affi+ t ID No.__________________

S!4SCRI4ED AND SWORN to befo!e )e this _______________ in the City of ____________ Philippines, affiant ha"ing e7hibited to )e he! co))unity ta7 ce!tificate no. _______________ issued on ______________ at _____________. Doc. No. _____ Page No. _____ Book No. _____ Series No. _____