REPUBLIC OF THE PHILIPPINES )

Province of Negros Oriental )

City of Dumaguete )S.S.
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AFFIDAVIT OF LOSS

I, ERALYN L. BELEN, of legal age, Filipino, married and currently residing in

Dumaguete City, Philippines, after having been sworn in accordance with law,
hereby deposes and states the following:

1. That I am married to Cpt Eraño B. Belen, member of the Philippine Air

Force and presently assigned at 205th Tactical Helicopter Wing. Being Cpt
Belen’s wife, I have been issued a Dependent Military ID.

2. That my husband, Cpt Belen, was the one in possession of my Dependent

ID.

3. That sometime on April 17, 2019, my husband discovered that my

Dependent ID was no longer in his possession. He might have been
misplaced the same while he was transferring from his previous
deployment in Cebu to his last deployment in Dingle, Iloilo.

4. That despite diligent search and efforts to locate my Dependent ID, my

husband and I could not find the same such that we now believe that it is
now lost beyond recovery.

5. Thus, on April 22, 2019, my husband filed a blotter report regarding the lost
of my Dependent ID. Attached hereto is the said Blotter Report.

6. That the said Dependent ID has not been confiscated by any government
agencies.

7. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support my application for the issuance of a new Military
Dependent ID and for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of April
2019 at Dumaguete City, Philippines.

ERALYN LLENO BELEN

Affiant
Driver’s License No. G02-17-000847

SUBCRIBED AND SWORN TO before me this 30th day of April 2019

in Dumaguete City, Philippines, affiant personally known to me to be the person
who executed and signed this affidavit.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.