REPUBLIC OF THE PHILIPPINES)
Bacolod City ) S.S.
x - - - - - - - - - - - - - - - - - -- -------- x
AFFIDAVIT OF LOSS
I, JOERGE C. JUMILLA, of legal age, Filipino, and a resident of Easthomes 2,
Brgy. Estefania, Bacolod City, Philippines, after having sworn to in accordance with law,
hereby depose and say:
1. That I am a bona-fide student of La Consolacion College (LCC) Bacolod City;
2. That I was issued a student’s ID for this purpose;
3. That while at the SM Mall-Bacolod City last February 16, 2012, I discovered
that my LCC School ID was no longer in my bag where I normally keep it
when outside the school campus. That despite diligent efforts to locate the said
lost LCC School ID of mine, I could not find it and I believe that the same is
lost beyond recovery.
4. That I execute this affidavit to attest to the truthfulness of the foregoing facts
and in support of my application for issuance of new school ID.
IN WITNESS WHEREOF, I have hereunto set my hand this
_______________________at Bacolod City, Philippines.
JOERGE C. JUMILLA
Affiant
SUBSCRIBED AND SWORN TO, before me this
___________________________ the affiant personally appeared to me and exhibited to
me his Community Tax Certificate _______________________issued on
____________________issued at Bacolod City and I have ascertained his identity to be
the same person who executed the foregoing affidavit
Doc. No.
Page No.
Book No.
Series of 2012
Doc. No._____
Page No._____
Book No.____
Series of 2012.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD . . . . . . . . . . . )S.S.
X - - - - - - - - - - - - - - - - - - - - - - - -X
AFFIDAVIT OF LOSS
I, _____________, of legal age, Filipino, married and a resident of Bacolod City,
Philippines, after having been sworn to in accordance with law, depose and state:
1.That I am a public school teacher assigned at Dona Julita M. Gatuslao
Memorial School, Himamaylan City, Occidental Negros, and as such a holder of
GSIS UMID Card;
2. That after issuance I kept it among my personal files for safekeeping.
However, lately I have discovered that my aforesaid GSIS UMID Card, is
nowhere to be found, as maybe I have misplaced it;
3. That I exerted diligent effort s to locate it, but I could no longer find the
GSIS UMID Card;
4. That I believe that the same is now totally lost and beyond recovery;
5. That I am executing this Affidavit of Loss to attest to the truth of the
foregoing.
IN WITNESS WHEREOF, I have hereunto unto set my hand this ____ day of
_____________ 2012 at Bacolod City, Philippines.
TARA A. VILLACANAS
Affiant
SUBSCRIBED AND SWORN TO before me this _____ day of ___________
2012, in the City of Bacolod. Affiant exhibited to me his GSIS eCard Plus ID No. 70000.
Doc. No. _______;
Page No. ______;
Book No. ______;
Series of 2012.
REPUBLIC OF THE PHILIPPINES)
Bacolod City ) S.S.
x - - - - - - - - - - - - - - - - - -- x
AFFIDAVIT OF LOSS
I, HEIDE TORRES, of legal age, Filipino, and a resident of Bacolod City,
Philippines, after having sworn to in accordance with law, hereby depose and say:
1. That I am presently working at TRANSCOM Worldwide at Brgy. Tangub,
City of Bacolod, and for this reason I was issued a UnionBank ATM Card;
2. That I accidentally loss my Unionbank ATM Card when I about to go home
after roaming around downtown area and despite diligent efforts was exerted in
order to locate it, but I could no longer find it;
3. That I now believe that the same is now totally lost and beyond recovery;
4. That I am executing this Affidavit of Loss to attest to the truth of the foregoing.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
____________ 2012 at Bacolod City, Philippines.
JESSEIL HERNAEZ
Affiant
SUBSCRIBED AND SWORN to before me this _____ day of ______ 2012, in the
City of Bacolod. Affiant who is personally known to me exhibited to me her TIN ID No.
______________; issued on ____________.
Doc. No. _______;
Page No._______;
Book No._______;
Series of 2012.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD . . . . . . . . )S.S.
X------------------x
AFFIDAVIT OF LOSS
I, FRANCIS C. NALANG, of legal age, Filipino, and a resident of Brgy.
Calumangan, Bago City, having been sworn to in accordance with law, do hereby depose
and say:
1. That on November 22, 2011, while I was riding in a public utility jeep, I was a
victim of pickpocket wherein my wallet which contains my Driver’s License,
TIN and some important documents were lost;
2. That diligent searched was exerted by me to find it but I could not find the
same despite my diligent efforts in trying to find it;
3. That the aforesaid documents were not transferred or indorsed to any third
person or confiscated by any authorized agency;
4. That I execute this Affidavit of Loss in order to attest to the truth of the facts
above-stated.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
____________ 2012 at Bacolod City, Philippines.
JESSEIL HERNAEZ
Affiant
SUBSCRIBED AND SWORN to before me this _____ day of ______ 2012, in the
City of Bacolod. Affiant who is personally known to me exhibited to me her TIN ID No.
______________; issued on ____________.
Doc. No. _______;
Page No._______;
Book No._______;
Series of 2012.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD . . . . . . . . )S.S.
X------------------x
AFFIDAVIT OF LOSS
I, ROSEMARIE MAHINAY, of legal age, Filipino, and a resident of Brgy.
Calumangan, Bago City, having been sworn to in accordance with law, do hereby depose
and say:
1. That I am the registered owner of a parcel of land covered by Transfer
Certificate of Title No. T-31564, which parcel of land is more particularly
described as follows:
TRANSFER CERTIFICATE OF TITLE
NO. T-31564
“A parcel of land (lot 13-A, Psd-06-056916 being a portion
of Lot 13, Psd-06-000268), situated in the Barangay of Atipulu-an,
City of Bago, Prov. of Negros Occidental, Island of Negros. Bounded
on the SW., x x x, containing an area of FIFTY THOUSAND
(50,000) SQUARE METERS, more
2. That as the owner, I was issued the owner’s duplicate copy of Transfer
Certificate of Title No. T-31564 which I keep in my clothing closet of
“aparador” together with my clothing;
3. That sometime on November 7, 2011, when I checked the said owner’s
duplicate copy of TCT No. T-31564 in the place where I kept, I found out that
the clothing together with my Owner’s Duplicate Copy of TCT No. 31564 are
eaten by termites and totally damaged and beyond recognition;
4. That my owner’s duplicate Transfer Certificate of Title No. T-31564 was not
encumbered, mortgaged, delivered or transferred to any other person;
5. That I execute this Affidavit in order to attest to the truth of the facts above-
stated and for the purpose of filing a petition in court for the issuance of
Second Owner’s Duplicate Copy of TCT No. T-31564.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
____________ 2012 at Bacolod City, Philippines.
ROSEMARIE MAHINAY
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of _________ 2012, in
the City of Bacolod. Affiant who is personally known to me exhibited to me her SSS ID
No. _____________________.
Doc. No. ________;
Page No. ________;
Book No. ________;
Series of 2012.
