Republic of the Philippines }

Province of Cagayan }S.S.

Municipality of _________ }

AFFIDAVIT OF LOSS

I, MARICEL B. ALFONSO of legal age, Filipino and a resident Sta. Barbara, Piat,
Cagayan after having been duly sworn to in accordance with law, deposes and states;

1. That I am one of the beneficiaries of the Pantawid Pamilyang Pilipino Program

(4Ps), as such savings account was duly issued in my favor by the Land Bank of the
Philippines in Tuguegarao City with Automated Teller Machine (ATM) Card No.
0215204-5631-8007-4;

2. That I used to put said ATM card in my wallet, unfortunately on October 19, 2016,
when I arrived home from work, I discovered that said ATM card was no longer in
my wallet;

3. That I tried to look for the said wallet in all the places where it might be but all
efforts proved futile, thus for all intents same is now considered lost and beyond
recovery.

4. That I am executing this affidavit to attest to the truth and veracity of the foregoing
facts and to support my request for the issuance of another ATM card in lieu of the
lost one.

IN WITNESS HEREOF, I have hereunto set my hand this 21 st day of November,

2016 at Piat, Cagayan.

MARICEL B. ALFONSO
Affiant

SUBSCRIBED and SWORN TO before me this 21 st day of November, 2016 at Piat,

Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor

Republic of the Philippines }

Province of Cagayan }s.s.
Municipality of _______ }

AFFIDAVIT OF LOSS

I, ARLENE D. OBBINIA, of legal age, Filipino, married and a resident of Sta

Barbara, Piat, Cagayan, after having been duly sworn to in accordance with law, deposes
and states:

1. That I am a holder of a Passport issued by the Department of Foreign Affairs,

Tuguegarao City;

2. That said Passport issued on January 21, 2010 and has expired last January
15, 2015;

3. That on May 01, 2016, while I was on my way to my residence at Sta Barbara,
Piat Cagayan from Centro, my bag which contained important documents
including said Passport was lost;

4. That I tried to look for the said bag in all the places where it might have fallen
but all efforts proved futile, thus for all intents same is now considered lost
and beyond recovery.

5. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and to support my request for the issuance of another
Passport in lieu of the lost one.

IN WITNESS HEREOF, I have hereunto set my hand this 10 th day of May, 2016 at
Piat, Cagayan.

ARLENE D. OBBINIA
Affiant

SUBSCRIBED and SWORN TO before me this 10 th day of May, 2016 at Piat,

Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor

Note: No available notary public in this Municipality

Republic of the Philippines }
Province of Cagayan }S.S.
Municipality of _____ }

AFFIDAVIT OF LOSS

I, ARLENE D. OBBINIA, of legal age, Filipino and a resident of Sta Barbara, Piat,
Cagayan, after having been duly sworn to in accordance with law, deposes and states;

1. That I am an owner/holder of a Passport issued by the Land;

2. That on January 5, 2015, while I was travelling from Baung Piat, Cagayan to
my residence at Poblacion 02 my wallet where I usually placed the said
Professional Drivers License and other important document was lost;

3. That I tried to look for the said wallet and other important document in all
the places where it might have fallen but all efforts proved futile, thus for all
intents, same is now considered lost and beyond recovery;

4. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this ______ day of January,
2015 at __________, Cagayan.

DANILO BINONDO
Affiant

SUBSCRIBED and SWORN TO before me this ______day of January, 2015 at

_______________, Cagayan

Doc No. _______

Book No. ______
Page No._______
Series of 2015
Republic of the Philippines }
Province of Cagayan }S.S.
Municipality of _____ }

AFFIDAVIT OF LOSS

I, ARLENE D. OBBINIA, of legal age, Filipino and a resident of Sta Barbara, Piat,
Cagayan, after having been duly sworn to in accordance with law, deposes and states;

5. That I am an owner of a motorcycle (RUSI TC-Z125) and as such I was issued

an Official Receipt (O.R.) and Certificate of Registration (C.R.) issued by the
Land Transportation Office;

6. That sometime on February 2016, while I was travelling from Piat Public
Market to my residence at Maguilling Piat, Cagayan I noticed that the said
Official receipt (O.R.) and Certificate of Registration (C.R.) was lost.

7. That I tried to look for the said documents in all the places where it might
have fallen or kept but all efforts proved futile, thus for all intents, same is
now considered lost and beyond recovery;

8. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 6 th day of April, 2016 at
Piat, Cagayan.

ROSALIA V. CASTILLO
Affiant

SUBSCRIBED and SWORN TO before me this 6th day of April, 2016 at Piat, Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor

Note: No available notary public in this Municipality

Republic of the Philippines }
Province of Cagayan }S.S.
Municipality of _____ }

AFFIDAVIT OF LOSS

I, JULIETA C. NOTO, of legal age, Filipino and a resident of Poblacion 01, Piat,
Cagayan, after having been duly sworn to in accordance with law, deposes and states;

9. That I am the wife of the late Gabriel Noto of Poblacion 01, Piat, Cagayan;

10. That when Gabriel died in June 3, 2007, he left behind a female horse
registered under his name which gavebirth to another female horse which is
now approximately 5 years old;

11. That I am executing this affidavit to request the Municipal Treasurers Office
to issue a certificate of ownership of said horse in my name :

12. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 18 th day of March, 2016 at
Piat, Cagayan.

JULIETA C. NOTO
Affiant

SUBSCRIBED and SWORN TO before me this 18 TH day of March, 2016 at Piat,

Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor

Note: No available notary public in this Municipality

Republic of the Philippines }

Province of Cagayan }S.S.
Municipality of _________ }
 AFFIDAVIT OF LOSS

I, SOFORONIO LANA, JR. of legal age, Filipino and a resident Sicatna Piat, Cagayan
after having been duly sworn to in accordance with law, deposes and states;

1. That I am an owner of a large cattle duly registered at the Municipality of

Piat, Cagayan, described as follows:

Age: 3 yrs
Gender: Female
Kind: Carabao

2. As such, I was issued a Certificate of Ownership but said Certificate of

Ownership was lost under my possession sometime in October, 2015;

3. That I tried to locate for the said Certificate of Ownership but all efforts
proved futile, thus for all intents same is now considered lost and beyond
recovery;

4. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 10 th day of March, 2016 at
Piat, Cagayan.

SOFORONIO LANA, JR.

Affiant

SUBSCRIBED and SWORN TO before me this 10th day of March, 2016 at Piat,
Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor
Administering officer

Note: No available notary public in this Municipality

Republic of the Philippines }

Province of Cagayan }S.S.
Municipality of _____ }
 AFFIDAVIT OF LOSS

I, JESUSA N. CASIBANG , of legal age, Filipino and a resident of Poblacion 02, Piat,
Cagayan, after having been duly sworn to in accordance with law, deposes and states;

13. That I am the wife of the late Oswaldo F. Casibang of Poblacion 02, Piat,
Cagayan;

14. That during the lifetime of my husband Oswaldo, we lived together under
one roof where we shared our properties together;

15. That when Oswaldo died in November 30, 2006, he left behind a female
carabao approximately 12 years old now and was registered under the name
of Oswaldo F. Casibang;

16. That I am executing this affidavit to request the Municipal Treasurers Office
to issue a new certificate of ownership of said carabao in my name :

17. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 29 th day of February, 2016
at Piat, Cagayan.

JESUSA N. CASIBANG
Affiant

SUBSCRIBED and SWORN TO before me this 29th day of February, 2016 at Piat,
Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor

Note: No available notary public in this Municipality

Republic of the Philippines }

Province of Cagayan }S.S.
Municipality of _________ }

AFFIDAVIT OF LOSS
 I, LOVELY B. BOQUIREN of legal age, Filipino and a resident Gumarrueng Piat,
Cagayan after having been duly sworn to in accordance with law, deposes and states;

5. That I am an owner of a Voters Identification Card duly registered at the

Municipality of Piat, Cagayan, described as follows:

6. That on December 29, 2015, while I was on my way going to office to our
house, my bag which contains important documents including said Voters
Identification Card was lost;

7. As such, I was issued a Voters Identification Card issued by the Comelec but
said ID was lost under my possession last December, 2015;

8. That I tried to locate for the said Voters Identification Card but all efforts
proved futile, thus for all intents same is now considered lost and beyond
recovery;

9. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 29 th day of December,

2015 at Piat, Cagayan.

LOVELY B. BOQUIREN
Affiant

SUBSCRIBED and SWORN TO before me this 29 th day of December, 2015 at Piat,

Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor
Administering officer

Note: No available notary public in this Municipality

Republic of the Philippines }

Province of Cagayan }S.S.
Municipality of _____ }
 AFFIDAVIT OF LOSS

I, JOHN A. BACULI, of legal age, Filipino and a resident of Poblacion 01, Piat,
Cagayan, after having been duly sworn to in accordance with law, deposes and states;

18. That I am an employee of the Local Government Unit of Piat, Cagayan;

19. As such, I was issued an Office Identification Card;

20. That on ______________, 2015, while I was travelling from Piat to Tuao,
Cagayan my bag where I placed the said Office Identification Card and other
important documents was lost;

21. That I tried to look for the said bag and other important documents in all the
places where it might have fallen but all efforts proved futile, thus for all
intents, same is now considered lost and beyond recovery;

22. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purpose it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this ______ day of December,
2015 at Piat, Cagayan.

JOHN A. BACULI
Affiant

SUBSCRIBED and SWORN TO before me this ______day of December, 2015 at

_______________, Cagayan

Republic of the Philippines }

Province of Cagayan }S.S.
Municipality of _________ }

AFFIDAVIT OF LOSS
 I, FLAVIANO FURAGGANAN of legal age, Filipino and a resident Poblacion 02 Piat,
Cagayan after having been duly sworn to in accordance with law, deposes and states;

10. That I am an owner of a large cattle duly registered at the Municipality of

Piat, Cagayan, described as follows:

Age: 27 yrs
Gender: Female
Kind: Carabao

11. As such, I was issued a Certificate of Ownership but said Certificate of

Ownership was lost under my possession sometime in September, 2014;

12. That I tried to locate for the said Certificate of Ownership but all efforts prove
futile, thus for all intents same is now considered lost and beyond recovery;

13. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 18 th day of November,

2015 at Piat, Cagayan.

FLAVIANO FURAGGANAN
Affiant

SUBSCRIBED and SWORN TO before me this 18 th day of November, 2015 at Piat,

Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor
Administering officer

Note: No available notary public in this Municipality

Republic of the Philippines }

Province of Cagayan }S.S.
Municipality of _____ }
 AFFIDAVIT OF LOSS

I, Lolita Juan , of legal age, Filipino and a resident of Aquib, Piat, Cagayan, after
having been duly sworn to in accordance with law, deposes and states;

23. That I am the cousin of the late Hilario Tattao of Aquib, Piat, Cagayan;

24. That during the lifetime of my cousin Hilario, we lived together under one
roof where we shared our properties together;

25. That when Hilario died in August 17, 2011 he left behind a male carabao
approximately 8 years old now;

26. That said carabao was registered under the name of Concepcion Cruz where
it was acquired by Hilario by way of sale;

27. That I am executing this affidavit to request the Municipal Treasurers Office
to issue a new certificate of ownership of said carabao in my name :

28. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 8 th day of July, 2015 at Piat,
Cagayan.

LOLITA JUAN
Affiant

SUBSCRIBED and SWORN TO before me this 6th day of August, 2015 at Piat,
Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor
Republic of the Philippines }
Province of Cagayan }S.S.
Municipality of _____ }

AFFIDAVIT OF LOSS

I, JAMES T. BION, of legal age, Filipino and a resident of Apayao, Piat, Cagayan,
after having been duly sworn to in accordance with law, deposes and states;

29. That I am an owner/holder of a Professional Drivers License issued by the

Land Transportation Office;

30. That on January 6, 2015, while I was travelling from Furagi Solana, Cagayan
to my residence at Apayao, Piat, Cagayan my wallet where I placed the said
Professional Drivers License and other important documents was lost;

31. That I tried to look for the said wallet and other important documents in all
the places where it might have fallen but all efforts proved futile, thus for all
intents, same is now considered lost and beyond recovery;

32. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purpose it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this ______ day of June, 2015 at
__________, Cagayan.

JAMES T. BION
Affiant
 SUBSCRIBED and SWORN TO before me this ______day of June, 2015 at
_______________, Cagayan

Republic of the Philippines }

Province of Cagayan }S.S.
Municipality/City of _______ }

AFFIDAVIT OF LOSS

I, DARIO V. ESTEBAN, of legal age, Filipino and a resident of Poblacion 01, Piat,
Cagayan after having been duly sworn to in accordance with law, deposes and states;

33. That I am a retired Armed Forces of the Philippines and as such I was issued an AFP
identification Card;

34. That last December 15, 2014 while I was travelling from Poblacion 01, Piat, Cagayan
to Gumarueng Piat, Cagayan on board a motorcycle my wallet which contains
important documents including said AFP Card was lost;

35. That I tried to look for the said wallet which contains said AFP Card and other
important documents in all the places where it might have fallen but all efforts
proved futile, thus for all intents same is now considered lost and beyond recovery;

36. That I am executing this affidavit to attest to the truth and veracity of the foregoing
facts and for whatever purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this ____ day of June, 2015 at
__________________, Cagayan.

DARIO V. ESTEBAN
Affiant

SUBSCRIBED and SWORN TO before me this _____ day of June, 2015 at

________________________________.
Republic of the Philippines }
Province of Cagayan }S.S.
Municipality/City of _______ }

AFFIDAVIT OF LOSS

I, Rosita C Agustin, of legal age, Filipino and a resident of Piat, Cagayan after
having been duly sworn to in accordance with law, deposes and states;

37. That I am a holder of PNB Bank Book issued by Philippine National Bank
Tuguegarao Branch, Tuguegarao City bearing Account No. 0740135015

38. That on December 18, 2015 while I was about to withdraw money from the said
Bank I found out that my Bank Book was lost

39. That I tried to look for the said Bank Book in all the places where it might be but all
efforts proved futile, thus for all intents same is now considered lost and beyond
recovery;

40. That I am executing this affidavit to attest to the truth and veracity of the foregoing
facts and for whatever purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this ____ day of Februar, 2016
at __________________, Cagayan.

Rosita C. Agustin
Affiant

SUBSCRIBED and SWORN TO before me this _____ day of February, 2016 at

________________________________.
Republic of the Philippines }
Province of Cagayan }S.S.
Municipality of _____ }

AFFIDAVIT OF LOSS

I, EMELIA E. TAMAYAO, of legal age, Filipino and a resident of Dugayung, Piat,

Cagayan, after having been duly sworn to in accordance with law, deposes and states;

41. That I am an owner/holder of a motorcycle bearing Plate No. 7526 BH;

42. As such, I was issued an Official Receipt (O.R.) and Certificate of Registration
(C.R.) issued by the Land Transportation Office; (copy of which is herewith
attached)

43. That on February 18, 2015, while I was in my residence at Dugayung Piat,
Cagayan, I noticed that the said Official receipt (O.R.) and Certificate of
Registration (C.R.) is no longer inside my tool-box where I usually keep
them.

44. That I tried to look for the said documents in all the places where it might
have fallen or kept but all efforts proved futile, thus for all intents, same is
now considered lost and beyond recovery;

45. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 2 nd day of March, 2015 at
Piat, Cagayan.

EMELIA E. TAMAYAO
Affiant

SUBSCRIBED and SWORN TO before me this 2 nd day of March, 2015 at Piat,

Cagayan.

ATTY. CARMELO O. VILLACETE

Municipal Mayor

Administering Offic

Republic of the Philippines }

Province of Cagayan }S.S.
Municipality of _____ }
 AFFIDAVIT OF LOSS

I, DANILO BINONDO, of legal age, Filipino and a resident of Poblacion 02, Piat,
Cagayan, after having been duly sworn to in accordance with law, deposes and states;

46. That I am an owner/holder of a Professional Drivers License issued by the

Land Transportation Office;

47. That on January 5, 2015, while I was travelling from Baung Piat, Cagayan to
my residence at Poblacion 02 my wallet where I usually placed the said
Professional Drivers License and other important document was lost;

48. That I tried to look for the said wallet and other important document in all
the places where it might have fallen but all efforts proved futile, thus for all
intents, same is now considered lost and beyond recovery;

49. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and for whatever legal purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this ______ day of January,
2015 at __________, Cagayan.

DANILO BINONDO
Affiant

SUBSCRIBED and SWORN TO before me this ______day of January, 2015 at

_______________, Cagayan

Doc No. _______

Book No. ______
Page No._______
Series of 2015