REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO) S.S.

x----------------------------x

AFFIDAVIT OF LOSS

I, Patrick James Tan, of legal age, Filipino citizen, single and a resident of
Brgy. Sto. Nino Slaughter House Baguio City, after having been duly sworn
to in accordance with law, do hereby depose and state:

1. That I am a current law student at the University of Baguio, Baguio City

Philippines.
2. That around 1600H while I was in the University of Baguio after paying in the
cahier’s office, I noticed that my wallet was lost which was usually placed in my
back pocket.
3. Inside my wallet are my Soliman Security Agency ID, Shields Security ID,
Security Officer’s License, TIN ID, PhilHealth ID, UMID ID, Pagibig ID, ATM
Cards (BDO, PNB and BPI), id pictures and cash worth Php 500.
4. That despite diligent search and efforts to locate the said wallet and inquiry
into the Marshall or Guard on Duty still I could not find them.
5. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing facts to the best of my knowledge and for whatever purpose this
affidavit might help.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 1st day of June
2018 at Baguio City, Philippines.

_____________________
School ID No: 20154454
Issued on: August 2015
At: University of Baguio,
Baguio City, Philippines