Republic of the Philippines )

Camiling, Tarlac )S.S.

AFFIDAVIT OF LOSS
I, MAR JAYSON DOMINGO BUNAO, 26 years old, Filipino citizen, single
and a resident of Barangay Birbira, Camiling, Tarlac, Philippines, after having been
duly sworn to in accordance with law do hereby depose and say THAT;

1. On June 29, 2017 in the evening, I boarded a passenger bus from Cubao,
Quezon City going to Camiling, Tarlac. I brought with me my wallet which
contained my Professional Drivers License Card, East West ATM Card,
some cash and other personal belongings;

2. Upon reaching the Town Proper of Camiling, Tarlac, I alighted from the
bus and took a tricycle going to our house and while in transit, I
discovered that my wallet was missing;

3. Right away, I searched for it inside the tricycle but I found nothing. Also, I
returned to the Camiling Bus Terminal, Camiling, Tarlac to look for the
bus I boarded from Cubao, Quezon City to Camiling, Tarlac but it was not
there anymore;

4. All the diligent efforts exerted to locate my wallet and its contents proved
futile; hence, I now consider them as lost and beyond recovery;

5. The incident was reported to the Camiling Police Station, Camiling,

Tarlac;

6. My professional drivers license card was never confiscated by any

authority or pledged to secure any obligation;

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 30th day

of June, 2017 at Camiling, Tarlac, Philippines.

MAR JAYSON D. BUNAO

Affiant

SUBSCRIBED AND SWORN to before me on the date and place indicated

above. Affiant exhibited before me his Voter ID Card with VIN: 6903-0037A-
A0191MDB10000 issued by the COMELEC, Camiling, Tarlac.

Doc. No.:______;
Page No.:______;
Book No.:______;
Series of 2017.