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Republic of the Philippines)

City of Zamboanga-----------) S.S.


x--------------------------------x

AFFIDAVIT OF LOSS

I, KRESLER G. ROMERO, of legal age, Filipino, married and a resident


of Old Housing, Bongao, Tawi-Tawi, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

That I am a regular employee of Department of Agrarian Reform Provincial


Office - Tawi-Tawi, designated as OIC-PARO II. As such, I am a member of
GSIS and was issued UMID Card.

That last month, out of inadvertence and excusable neglect said UMID Card
was misplaced and nowhere to be found;

That despite diligent search and efforts to locate the said UMID Card, the same
cannot be found and is now considered lost beyond recovery;

That I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my request for issuance of the another Card in lieu of the lost
one.

IN WITNESS WHEREOF, I have hereunto set my hand this 25thday of


July, 2017 at Zamboanga City, Philippines.

KRESLER G. ROMERO
Affiant

SUBSCRIBED AND SWORN to before me this 25th day of July, 2017, in


the City of Zamboanga, Philippines, Affiant exhibited to me his ID
No.__________ issued on ___________________ at Zamboanga City.

ATTY. LANOEL S. LAJA


Notary Public
Until December 31, 2017
Doc. No. ____ Notarial Commission No. 70-2016
Page No. ____ Roll No. 65138; 6/ 17/ 2016
Book No.____ IBP No. 1063800; 01/10/2017
SERIES OF 2017 PTR No. 1387463; 01/03/2017, Zamboanga City
Republic of the Philippines)
City of Zamboanga-----------) S.S.
x--------------------------------x

AFFIDAVIT OF LOSS

I, Hanafjan Que Ibañez, of legal age, Filipino, single and a resident of


Ilang-ilang drive Villa Sta. Maria, Zamboanga City, Philippines, after being duly
sworn to in accordance with law, hereby depose and state:

That I am a Registered Nurse. As such, I was issued by PRC a Certificate of


Registration with number 0861032 on 07 July,2015;

That out of inadvertence and excusable neglect said Certificate of Registration


was misplaced and nowhere to be found;

That despite diligent search and efforts to locate the said Certificate of
Registration, the same cannot be found and is now considered lost beyond
recovery;

That I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my request for issuance of another Certificate of Registration in
lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of


July, 2017 in the City of Zamboanga , Philippines.

Hanafjan Que Ibañez


Affiant

SUBSCRIBED AND SWORN to before me this 27th day of July, 2017, in


the City of Zamboanga, Philippines, Affiant exhibited to me his/her ID No.
__________________ issued on ________________ at Zamboanga City.

ATTY. LANOEL S. LAJA


Notary Public
Until December 31, 2017
Doc. No. _____ Notarial Commission No. 70-2016
Page No. _____ Roll No. 65138; 06/ 17/ 2016
Book No.______ IBP No. 1063800; 01/10/2017
SERIES OF 2017 PTR No. 1387463; 01/03/2017, Zamboanga City
Republic of the Philippines)
City of Zamboanga-----------) S.S.
x--------------------------------x

AFFIDAVIT OF LOSS

I, PHILIP BENJAMIN S. MICUBO, of legal age, Filipino, single and a


resident of Guiwan, Zamboanga City, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

That I am a Licensed Real Estate Broker. As such, I regularly receive and


process documents and or payments for and in behalf of my clients;

That in the process of making the reservation for a House and Lot for client-
Maricel Estoquia-Wee, I paid and was issued an Official Receipts (O.R.) for the
sum of TEN THOUSAND (P 10,000.00) PESOS only by Camella, San Ezekiel,
Zamboanga City in the said client’s name;

That the said O.R. must be surrendered to Camella, San Ezekiel Zamboanga
City in order to refund the sum thereto;

That the said O.R. can no longer be surrendered because the same was
misplaced in my possession due to excusable neglect and/ or inadvertence;

That I have exerted diligent effort in the search for the said O.R. but all prove
futile and that the same is now considered lost beyond recovery;

That I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my request for refund of the amount covered by the said O.R.
sans its submission;

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of


June, 2017 at Zamboanga City, Philippines.

PHILIP BENJAMIN S. MICUBO


Affiant

SUBSCRIBED AND SWORN to before me this 15th day of June, 2017, in


the City of Zamboanga, Philippines, Affiant personally known to me.

ATTY. LANOEL S. LAJA


Notary Public
Until December 31, 2017
Doc. No. _____
Notarial Commission No. 70-2016
Page No. _____
Roll No. 65138; 06/ 17/ 2016
Book No.______
SERIES OF 2017 IBP No. 1063800; 01/10/2017
PTR No. 1387463; 01/03/2017, Zamboanga City
Republic of the Philippines)
City of Zamboanga-----------) S.S.
x--------------------------------x

AFFIDAVIT OF LOSS

I, AMELITA A. BEJERANO, of legal age, Filipino, married and a resident


of Don Alfaro St., Tetuan, Zamboanga City, Philippines, after being duly sworn
to in accordance with law, hereby depose and state:

That I am already a Senior Citizen. As such, I was issued Senior Citizen ID


Card Number 021344 on 08-04-2010 at Zamboanga City;

That out of inadvertence and excusable neglect said Senior Citizen ID Card was
misplaced and nowhere to be found;

That despite diligent search and efforts to locate the said Senior Citizen ID
Card the same cannot be found and is now considered lost beyond recovery;

That I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my request for issuance of another Senior Citizen ID Card in
lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of


________, 2017 in the City of Zamboanga , Philippines.

AMELITA A. BEJERANO
Affiant

SUBSCRIBED AND SWORN to before me this ___day of _________, 2017,


in the City of Zamboanga, Philippines, Affiant exhibited to me her ID No.
__________________ issued on ________________ at Zamboanga City.

ATTY. LANOEL S. LAJA


Notary Public
Until December 31, 2017
Doc. No. _____ Notarial Commission No. 70-2016
Page No. _____ Roll No. 65138; 06/ 17/ 2016
Book No.______ IBP No. 1063800; 01/10/2017
SERIES OF 2017 PTR No. 1387463; 01/03/2017, Zamboanga City
Republic of the Philippines)
City of Zamboanga-----------) S.S.
x--------------------------------x

AFFIDAVIT OF LOSS

I, OMARKHAN H. ARIPIN, of legal age, Filipino, married and a resident


of Kepeng, Tandubas, Tawi-Tawi, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

That I am a regular member of GSIS. As such, I was issued a Policy Contract


and GSIS E- Card by the GSIS in Zamboanga City;

That out of inadvertence and excusable neglect said Policy Contract together
with the GSIS E-Card were misplaced and nowhere to be found;

That despite diligent search and efforts exerted in order to find the said
documents, the same could no longer be located and are now considered lost
beyond recovery;

That this Affidavit of Loss is executed to attest to the truth of the foregoing and
for purposes of the re-issuance of the said Policy Contract and GSIS E-Card in
my favor and for whatever legal purposes it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this ____thday of


___________, 2017 at Zamboanga City, Philippines.

OMARKHAN H. ARIPIN
Affiant

SUBSCRIBED AND SWORN to before me, this ___th day of _______, 2017,
in the City of Zamboanga, Philippines, Affiant exhibited to me his ID
No.__________ issued on ___________________ at Zamboanga City.

ATTY. LANOEL S. LAJA


Notary Public
Until December 31, 2017
Doc. No. ____; Notarial Commission No. 70-2016
Page No. ____; Roll No. 65138; 6/ 17/ 2016
Book No.____; IBP No. 1063800; 01/10/2017
SERIES OF 2017 PTR No. 1387463; 01/03/2017, Zamboanga City
SUBSCRIBED AND SWORN to before me, this ___th day of _______, 2017, in the
City of Zamboanga, Philippines, Affiant exhibited to me her ID No.__________
issued on ___________________ at Zamboanga City.

ATTY. LANOEL S. LAJA


Notary Public
Until December 31, 2017
Doc. No. ____; Notarial Commission No. 70-2016
Page No. ____; Roll No. 65138; 6/ 17/ 2016
Book No.____; IBP No. 1063800; 01/10/2017
SERIES OF 2017 PTR No. 1387463; 01/03/2017, Zamboanga City
Republic of the Philippines)
City of Zamboanga-----------) S.S.
x--------------------------------x

AFFIDAVIT OF LOSS

I, ZHAFRA M. ARIPIN, of legal age, Filipino, married and a resident of


Sallangan, Tandubas, Tawi-Tawi, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

That I am a regular member of GSIS. As such, I was issued a Policy Contract


by the GSIS in Zamboanga City;

That out of inadvertence and excusable neglect said Policy Contract was
misplaced and nowhere to be found;

That despite diligent search and efforts exerted in order to find the said
document, the same could no longer be located and is now considered to be
lost beyond recovery;

That this Affidavit of Loss is executed to attest to the truth of the foregoing and
for purposes of the re-issuance of the said Policy Contract in my favor and for
whatever legal purposes it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this ____thday of


___________, 2017 at Zamboanga City, Philippines.

ZHAFRA M. ARIPIN
Affiant

SUBSCRIBED AND SWORN to before me, this ___th day of _______, 2017,
in the City of Zamboanga, Philippines, Affiant exhibited to me her ID
No.__________ issued on ___________________ at Zamboanga City.

ATTY. LANOEL S. LAJA


Notary Public
Until December 31, 2017
Doc. No. ____; Notarial Commission No. 70-2016
Page No. ____; Roll No. 65138; 6/ 17/ 2016
Book No.____; IBP No. 1063800; 01/10/2017
SERIES OF 2017 PTR No. 1387463; 01/03/2017, Zamboanga City