REPUBLIC OF THE PHILIPPINES )

) S.S.
x-----------------------------------------------x
AFFIDAVIT OF LOSS
I, Sven Luis dela Cruz, of legal age, Filipino, single, and a
resident of 80 Poblacion Sur, Pasuquin St. Paniqui, Tarlac, after
having been duly sworn to in accordance with law, depose and
state that:
1. On or about 3:30 A.M. of 03 April 2015, inside a room in
Irma Clarita delos Reyes Bocobo transient house located
at 12 F. Baltazar St., Gibraltar, Baguio City, unidentified
suspect/s broke into the house and stole my belongings
while I was sleeping;
2. Among my stolen belongings are the following:
2.1

Non-Professional Drivers License

2.2.

Tax Identification Number card

2.3

PAG-IBIG ID card;

3. 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 Non-Professional Driver's
License, Tax Identification Number card, and PAG-IBIG
ID card.
IN WITNESS WHEREOF, I have hereunto set my hand
this ___________________ in ________________________.
____________________
Sven Luis dela Cruz
Affiant
SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in _________________, , affiant exhibiting to
me his
competent
evidence
of
identity
by
way
of
______________________________
issued
at
______________
on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;

Series of 2015