Republic of the Philippines)

Province of Quirino) S.S.

Municipality of Diffun)
x-----------x
AFFIDAVIT OF LOSS
I, BOBBY A. ABALAHIN, JR., of legal age, married, Filipino and a resident of
Cordon, Isabela, having been duly sworn in accordance with law, hereby depose
and state:

1.That I am the owner of the TOP;

2. That sometime in the year 2009, I noticed that the said TOP was missing;
3. That to my knowledge, the said TOP was lost;
4. That I took great pains to look for the said TOP but no avail;
5. As such, I am executing this affidavit to attest to the truth foregoing facts
and to support the application for the issuance of a new one in lieu of the one
which was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of May 2018, at
Diffun, Quirino, Philippines.

BOBBY A. ABALAHIN, JR.

Affiant
PRC ID No. 0276095

SUBSCRIBED and SWORN TO before me on the date and at the place indicated
below. The affiant exhibited to me his competent evidence of identity as
indicated above.
Signed this 30th day of May 2018 at Diffun, Quirino.

WITNESS MY HAND AND SEAL.

Atty. MA. KAREN A. BALDONADO-GUILLERMO

Notary Public
Until December 31, 2019
Doc No: PTR No. 3218465/ 01-03-2018
Page No: Lifetime IBP No. 17396/05-20-2017
Book: ROLL No. 67812/05-26-2017
Series of 2018. (MCLE Governing Board Order No. s-2008)
Diffun, Quirino