REPUBLIC OF THE PHILIPPINES )

CITY OF MANDAUE
) S.c.
AFFIDAVIT OF LOSS
I, ULYSSES JOHN PO TAN, of legal age, Filipino married, and a
resident of Don Gervacio Quijada Street, South Plain Subdivision, Cebu
City, after being sworn to in accordance with law, depose and say that:
1.
I was previously issued a Sunlife Financial Philippines ID
(Redwood-Cebu Branch)with code number 083805;
2.
pocket;

I used to keep the above-mentioned evidence of identity in my

3.
Few days ago, while I was on my way to my workplace, I
accidentally left the said ID;
4.
find it;
5.

I tried all efforts to locate the subject ID but I was not able to
The ID is now beyond recovery; and

6.
I am executing this sworn statement, as required, to enable me
to obtain a replacement for the said lost document.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day
of August 2015, in the City of Mandaue, Philippines.

ULYSSES JOHN PO TAN

Affiant
JURAT
SUBSCRIBED and sworn to before me, this ___ day of August 2015,
in the City of Mandaue by affiant with the following competent evidence of
identity:
Evidence of Identity
TIN ID

ID Number
248-691-557000

Validity Date
Up to Present

Issued At
BIR

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2015.
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