Republic of the Philippines )

Camiling, Tarlac
)S.S

AFFIDAVIT OF LOSS
I, ALDRENE NICOLAS y DELA CRUZ, 27 years old, Filipino citizen, married
and a resident of Barangay Libueg, Camiling, Tarlac, Philippines, after having been
duly sworn to in accordance with law, do hereby depose and state THAT:
1. While on my way to work on board my tricycle on January 3, 2017 at around
5:00AM, I noticed that my wallet which I earlier placed in the front
compartment of my tricycle was missing;
2. My wallet contained my Professional Drivers License Card, Voter ID Card,
Cebuana Lhuiller pawn ticket, Petron Tricycle Card, machine copies of the
Certificate of Registration and Official receipt of my motrocycle, some cash
and other personal belongings;
3. Immediately, I search my wallet inside the tricycle but I found nothing. Also, I
went back along the road to search for my missing wallet but it was in vain;
4. The incident was reported to the Camiling Police Station, Camiling, Tarlac;
5. All my diligent efforts to locate my wallet and its contents proved futile;
hence, I now consider them as lost and beyond recovery;
6. The above-said license/cards/IDs were neither confiscated by any authority
or pledged to secure any obligations;
7. I am executing this Affidavit to attest to the truth of the foregoing statements
and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 5 th day of
January, 2017 at Camiling, Tarlac, Philippines.
ALDRENE D. NICOLAS
Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated
above. Affiant exhibited to me his Philippine Passport with Number EC1139811 issued
by the Department of Foreign Affairs, Pampanga on May 19, 2014, valid until May 18,
2019.

Doc. No._______;
Page No._______;
Book No._______;
Series of 2016.