AFFIDAVIT OF LOSS
That last July 16, 2013, I was in Mt. Carmel Parish Church in Enrique Villanueva,
Siquijor to attend the town fiesta in the said place;
That at around 10:30 o’clock in the morning while I attended the Mass at Mt Carmel
Church I placed my wallet at the pew of the Church, unfortunately, I forgot to get and bring
my said wallet after the mass and I left it where it was placed when I attended the mass;
That I went back to Church after three hours and my wallet could no longer be found;
That what were inside my wallet were the following important document and papers,
to wit:
1. ATM (UCPB)
2. DCCCO Identification Card ID No. 09639-4
3. Non Professional Driver’s License No. GO2-049319
4. Pawn Ticket No. 40506 SG00 9882 of Cebuana Lluihler
5. Cash of Php5,000.00 & $3
6 PHILHEALTH ID
That I have reported the said incident to the Police Station in Enrique Villanueva,
Siquijor and I have exerted all efforts to locate the aforementioned items, but despite diligent
efforts exerted to locate them, the same can no longer be found;
That this affidavit is executed freely and voluntarily just to attest the truthfulness and
veracity of the statements alleged herein.
ANECITA B. CABALUNA
(Affiant)
CTC NO. 25021807
Issued on January 16, 2013
At Dumaguete City
SUBSCRIBED AND SWORN to before me, this ___day of July 2013, at Sibulan,
Negros Oriental.
TIRSO F. BANQUERIGO
Circuit Trial Judge