Affidavit Of Loss.docx

REPUBLIC OF THE PHILIPPINES) CITY OF _________________) S.S.

AFFIDAVIT OF LOSS

I, _ , Filipino, of legal age, single and a resident of _ , after having duly sworn to in accordance with law, hereby depose and say that: 1. I am a holder of an Architect License Card issued by the Professional Regulation Commission; 2. My wallet was stolen together with the said identification card on February 18, 2017 at one of the Baliwag Incorporated bus and that I exerted all efforts to locate the culprit but to no avail and it is considered lost for all legal purposes; 3. Said Identification Card was not confiscated by any officer of the law by reason of any violation of any law, ordinance, presidential decree or rules and regulation of the said Commission; and neither was it offered as collateral for any loan; I am executing this affidavit to attest to the foregoing facts;

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd of March in the city of San Juan.

_ Affiant

SUBSCRIBED AND SWORN to before me this _________________in the city of _________________, Philippines, affiant having exhibited to me her passport with no. EC6222814 issued at DFA Pampanga.

Doc. No. _______ Book No. ______ Page No. ______ Series of 2017