Republic of the Philippines)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - --x
AFFIDAVIT OF LOSS
I, ABRAHAM P. DUMAPIAS, single, Filipino, of legal age, , and a
resident of Davao City, after being duly sworn to in accordance with law do
hereby depose and say that:
1. I am the owner of a valid Voters ID as issued by the Commission of
Elections of Davao City.
2. On or around May of 2011, I accidentally misplaced the said Voters
ID, and despite diligent efforts to locate it, the same was never fond
hence declared to all intents and purposes lost and beyond recovery.
3. I am executing this affidavit without any fraud or intent to deceive on
my part and I forever free any person from any liability that may
arise from this circumstance, and/or any entity, be it governmental or
private.
4. I attest to the truth of the foregoing statements to the best of my own
personal knowledge and based on authentic documents or records. I
am executing this Affidavit of Loss to support my application for a
new Voters ID, as well as for all lawful intents and purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________ at Davao City, Philippines.
ABRAHAM P. DUMAPIAS
Affiant
SSS No. 09-2409404-0
SUBSCRIBED and SWORN to before me, in the City of Davao,
______________________, affiant exhibiting to me his/her competent
evidence of identity first written above below his/her name.
Doc No.________
Page No.________
Book No.________
Series of 2016.