Wallet-Vivian Paciteng

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Republic of the Philippines )

Baguio City ) SS.

AFFIDAVIT OF LOSS
I, RAMIL F. AGUMBA, of legal age, married, Filipino Citizen with residence and
postal address at #119 Purok 21, San Carlos, Irisan, Baguio City, Philippines, after having been
duly sworn to in accordance with law do hereby, depose and say:

1. That I am an owner of a wallet containing the following Valid IDs and ATM Card:

1. PROFESSIONAL DRIVERS LICENSE


2. BDO ATM CARD
3. TIN NUMBER ID
4. CEBUANA CARD
5. VOTERS ID

2. That said wallet was lost on April 2, 2017 at around 5:30PM, while I was busy
entertaining my client at the Burnham Park, Baguio City particularly at the biking
area. I hanged my white jacket at the tent of my stall and after 10 minutes when I
returned I was surprised that my black wallet placed in my jacket was already
missing;

3. That I exerted diligent effort to find the said wallet but to no avail, hence, considered
forever lost;

4. That the said VALID IDENTIFICATION CARDS AND ATM 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 PROFESSIONAL
DRIVERS LICENSE, BDO ATM CARD, TIN NUMBER ID, CEBUANA
CARD, and VOTERS ID, 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 6th day of April, 2017, at
Baguio City, Philippines.

RAMIL F. AGUMBA
Affiant

SUBSCRIBED AND SWORN TO before me this 6th day of March, 2017 at Baguio
City, Philippines. Affiant personally appeared before me and represented to me himself 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. 37; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 008; BIR TIN No. 121-017-652
Book No. XXII; No. 19, 2nd Floor Old Market Bldg.,
Series of 2017. Magsaysay Ave., Baguio City, Philippines

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