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Republic of the Philippines)

City of Cotabato.)s.s.
AFFIDAVIT OF LOSS

I, MAKIM A. MUJALA, Filipino, of legal age, married to Senita A. Muddalan and a
resident of Rosary Heights 10, Cotabato City after having been duly sworn in accordance
with law, hereby depose and say:

1. That I am a holder of the following:
a. Office ID (Regional Human Rights Commission-ARMM),
b. School ID. St. Benedict College of Cotabato City,
c. ATM Card LandBank and MetroBank,
d. TIN ID,
e. PhilHealth ID,
f. Drivers License,
g. Cedula, and
h. Pledge Receipt .

2. That I used to put said items in my pouch;

3. That sometime on May 4, 2014 around 7 pm, I and my companion Timhar Musa ate
dinner in Kitoks Restaurant near the Manongs Store after that, we went home. Upon
arrival at our residence, I discovered that my wallet was no longer in my pouch where
I used to place it.

4. Despite diligent search and efforts to locate said document, I could not find it;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to
request for a replacement of said school/company ID cards from Regional Human
Rights Commission-ARMM, Landbank of the Philippines, Metrobank, Bureau of
Internal Revenue, Philhealth Insurance Corp. and Land Transportation Office and the
Pledge receipt from Deal Pawnshop.


IN WITNESS WHEREOF, I have here unto affixed my signature this ____ day of
____________ 20___ at ________________________, Philippines.




______________________________________
(Signature of Affiant over Printed Name)




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SUBSCRIBED AND SWORN TO before me, a notary public in and for
_____________________ this ____ day of ____________ 20___. The affiant, whom I
identified through the following competent evidence of
identity: _____________________________, valid
from __________________to __________________ issued by ________________________
__, personally signed the foregoing instrument before me and avowed under penalty of law to
the whole truth of the contents of said instrument.



Notary Public
Doc. No. ........;
Page No. .......;
Book No. .......;
Series of 20___.