Republic of the Philippines )

Baguio City ) SS.

AFFIDAVIT OF LOSS
I, REMEDIOS A. CAMEG, of legal age, widow, Filipino Citizen with
residence and postal address at Tocucan, Bontoc, Mt. Province, Philippines,
after having been duly sworn to in accordance with law do hereby, depose
and say:

1 That I am a holder of AFP BENEFICIARY ID Card and PVAO ID

Card;

2 That I lost the said IDENTIFICATION CARDS on March 20, 2017. I

was at the Rice Section of City Public Market of Baguio when I
discovered that my AFP Beneficiary and PVAO ID Cards which I
kept in cellophane were missing. I usually kept the aforementioned
ID Cards in my bag;

3 That I probably lost or dropped the said ID Cards unknowingly while

I was bringing in and out my wallet. I exerted diligent effort to find
the said wallet but to no avail, hence, considered forever lost;

4 That the said AFP BENEFICIARY ID Card and PVAO ID Card were
never given nor pledged to anyone for any purpose whatsoever, nor
were taken or confiscated by the authorities for any violation of the
law; and

5 That I am executing this affidavit to attest to the veracity and

truthfulness of my foregoing statements and to request for the
issuance of a new AFP BENEFICIARY ID Card and PVAO ID
Card, in lieu to the lost one and for all legal intents and purposes it
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 21st day of

March, 2017, at Baguio City, Philippines.

REMEDIOS A. CAMEG
Affiant
Senior Cit. ID No. 010120108
Issued On: April 11, 2011

SUBSCRIBED AND SWORN TO before me this 21st day of March,

2017 at Baguio City, Philippines. Affiant personally appeared before me and
represented to me herself to be the same person who executed this
instrument freely and willingly.

MODESTO T. ANDONG
Notary Public
Commission No. 35-NC-16-R/Until: December 31, 2017
PTR No. 2945281/01-05-2017/Baguio City
IBP No. 1056844/01-05-2017/Baguio-Benguet Chapter
 Roll No. 31289/5-15-81/Manila
Doc. No. 400; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 80; BIR TIN No. 121-017-652
Book No. XXI; No. 19, 2nd Floor Old Market Bldg.,
Series of 2017. Magsaysay Ave., Baguio City, Philippines