Affidavit Loss Claimstub-Claim Stub

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REPUBLIC OF THE PHILIPPINES)

CITY OF MANDAUE …………………)S.S.

AFFIDAVIT OF LOSS
Re: Claim Stub of ACR I-Card

I, Eric Gerald Crowley, of legal age, citizen of USA, single and a resident
of 7 Brothers of St. John Compound, Good Shepherd Road, Banawa
Guadalupe, Cebu City, Cebu, after having duly sworn to in accordance with
law, do hereby depose and state: THAT-

1. I have applied for issuance of an ACR I-Card before the office of Bureau
of Immigration and have submitted the full documentary requirements.

2. I was issued with a claim stub instructing me to claim the copy of my


ACR I-Card;

3. However, when I was about to claim the passport I could not locate
anymore the claim stub;

4. I immediately exerted diligent efforts to find the claim stub but all proved
futile;

5. I consider the claim stub as lost and beyond recovery;

6. The claim stub was not confiscated by or encumbered to any government


or private instrumentality; and

7. I execute this affidavit to attest to the truth of all the foregoing facts, in
order to support my request for the release of my ACR I-Card, and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this


December 13, 2019 at Mandaue City, Cebu.

ERIC GERALD CROWLEY


Affiant

SUBSCRIBED AND SWORN to before me a Notary Public this December


13, 2019 in Mandaue City, Cebu, Philippines, affiant exhibited to me his USA
Passport No. 538791861 valid until 04 Dec 2025 as competent evidence of
identity, known to me to be the same person who executed this Affidavit and I
am convinced that he understood the averments hereof.

DOC. NO…………
PAGE NO………..
BOOK NO………..
SERIES OF 2019.

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