REPUBLIC OF THE PHILIPPINES)
LIPA CITY )S.S.
AFFIDAVIT OF LOSS
I, Kristian Ian Dale Datinguinoo, of legal age, single and residing at Block 4 Lot 4
Brixton Homes Subdivision, Brgy. Balintawak, Lipa, Batangas City after having been duly
sworn to according to law hereby depose and state:
1. That I am the designated representative of Mr. Francisco M. Datinguinoo and Mrs.
Valentina Cabungcal in relation to their property situated in Block 4 Lot 4 Brixton
Homes Subdivision located at Brgy. Balintawak Lipa City, Batangas;
2. That as part of the house improvement procedure I acquired house improvement permit
along with a house improvement banner;
3. That after said improvement the house improvement banner has been lost;
4. That after diligent search said banner was nowhere to be found anymore;
5. That I am executing this affidavit in order to attest to the truth of the foregoing
circumstances and for the purpose of reporting the loss to the Engineering Department of
the said subdivision.
IN WITNESS WHEREOF, I have hereunto set my hand this 02 May 2019 at the City of
Lipa.
_____________________________________
Signature of Affiant
SUBSCRIBED AND SWORN to before me, this _________________ by
______________________________ who exhibited to me his
_______________________________ issued at _______________________, Philippines on
___________________.
_________________________________
Notary Public
REPUBLIC OF THE PHILIPPINES)
LIPA CITY )S.S.
AFFIDAVIT OF LOSS
I, Kristian Ian Dale Datinguinoo, of legal age, single and residing at Block 4 Lot 4
Brixton Homes Subdivision, Brgy. Balintawak, Lipa, Batangas City after having been duly
sworn to according to law hereby depose and state:
1. That I am the designated representative of Mr. Vhio Hernandez and Mrs. Placida
Cabungcal in relation to their property situated in Block 4 Lots 12 and 14 Brixton Homes
Subdivision located at Brgy. Balintawak Lipa City, Batangas;
2. That as part of the house improvement procedure I acquired house improvement permit
along with a house improvement banner;
3. That after said improvement the house improvement banner has been lost;
4. That after diligent search said banner was nowhere to be found anymore;
5. That I am executing this affidavit in order to attest to the truth of the foregoing
circumstances and for the purpose of reporting the loss to the Engineering Department of
the said subdivision.
IN WITNESS WHEREOF, I have hereunto set my hand this 02 May 2019 at the City of
Lipa.
_____________________________________
Signature of Affiant
SUBSCRIBED AND SWORN to before me, this _________________ by
______________________________ who exhibited to me his
_______________________________ issued at _______________________, Philippines on
___________________.
_________________________________
Notary Public
