REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S. S.

AFFIDAVIT OF LOSS
I, FRANCIS RASCO BAAGA, of legal age, Filipino, single and a resident of
Acacia Street, Rainbow Village, Phase 5, Bagumbong, Caloocan City, after having duly
sworn to in accordance with law hereby depose and say:
1. That I am a lawful holder of the following:
a. Professional
Drivers
License
bearing
License
No.
_________________ duly issued to me by the Land Transportation
Office (LTO) with expiry date of October 10, 2007; and
b. ATM Card for my payroll issued to by METROBANK, Masangkay
(Binondo) Branch;
2. That at 12:00 midnight of July 2, 2006, while I was boarding a passenger bus
from Bicutan to Novaliches, Quezon City, being in a deep sleep, I was not
able to notice that my pants front pocket was slashed by an unscrupulous
person who unlawfully took my Drivers License, Cellular Phone and ATM
Card including my cash money placed therein. That it was only upon
alighting the said passenger vehicle that I noticed the loss of the aforesaid
belongings;
3. That all efforts to recover the said items proved in vain and for all purposes
considered lost;
4. That I wish to declare and manifest that said Drivers License was not
endorsed to anybody nor confiscated from me by any person in authority for
any traffic violation but simply lost by reason of the above-mentioned
circumstances;
5. That I have executed this affidavit to attest to the truth of all the foregoing and
to satisfy the inquiry or requirements of any person or office particularly the
Land Transportation Office (LTO) and METROBANK for purposes of securing
a replacement of my drivers license and ATM Card, respectively, and for
other legal intents and purposes it may serve.
FURTHER, AFFIANT SAYETH NAUGHT.

FRANCIS RASCO BAAGA

Affiant
SUBSCRIBED AND SWORN to before me this 3 rd day of July 2006 in Quezon
City, Metro Manila, Affiant exhibited to me his Res. Cert. No. _______________ issued
on _______________ at ___________________.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2006.

Notary Public

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S. S.
AFFIDAVIT OF LOSS
I, RENATO CORONADO PROVIDENCIA, of legal age, Filipino, single and a
resident of 28 Paltok, Palanza, Bgy. Doa Imelda, Quezon City, after having duly sworn
to in accordance with law hereby depose and say:
6. That I am a lawful holder of Professional Drivers License duly issued to me
by the Land Transportation Office (LTO), which license is valid until April 10,
2009;
7. That my said Drivers License has been misplaced and/or lost last January
25, 2006 while I was on my way to the Barangay Hall of Bgy. Doa Imelda,
from Galas Market, Quezon City;
8. That I tried all diligent search to recover said Drivers License but all efforts
proved in vain and for all purposes considered lost;
9. That I wish to declare and manifest that the above-mentioned drivers license
was not entrusted to anybody nor confiscated from me by any person or
agent of persons in authority for any traffic violation but simply lost and now
beyond recovery;
10. That I have executed this affidavit to attest to the truth of all the foregoing and
to satisfy the inquiry or requirements of any person or office particularly the
Land Transportation Office (LTO) anent my desire to secure a replacement of
said Drivers License in lieu of the lost one and for other legal intents and
purposes it may serve.
FURTHER, AFFIANT SAYETH NAUGHT.

RENATO CORONADO PROVIDENCIA

Affiant
SUBSCRIBED AND SWORN to before me this 6 th day of February 2006 in
Quezon City, Metro Manila, Affiant exhibited to me his C.T.C. No. _______________
issued on __________________ at __________________.

Doc. No. _________;

Page No. _________;
Book No. _________;

Notary Public

Series of 2006.

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA) S.S.

AFFIDAVIT OF LOSS
I, TELMAR M. RAFAEL, of legal age, Filipino, single and with residence address
at 139 E. Garcia St., Cubao, Quezon City, after having duly sworn to in accordance with
law hereby depose and say:
1. That I an owner/holder of a Digitized SSS I.D. with SSS No. 33-22629360;
2. That last May 08, 2005 at about 7:30 in the evening, my wallet containing
some cash money and my said SSS I.D. was snatched from my pants pocket
while boarding a PUJ jitney from E. Rodriguez Sr. Blvd. to Aurora Blvd.,
Cubao, Quezon City;
3. That as of this date, my said wallet with my SSS I.D. not recovered and for all
purposes considered lost;
4. That I have executed this affidavit to attest to the truth of all the foregoing and
to satisfy the inquiry or requirements of any person or office particularly the
Social Security System for all legal intents and purposes it may serve.
FURTHER, AFFIANT SAYETH NAUGHT.
TELMAR M. RAFAEL
Affiant
SUBSCRIBED AND SWORN to before me this 26th day of May. 2005 in Quezon
City, Metro Manila.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2005.

Notary Public