REPUBLIC OF THE PHILIPPINES )

CITY OF MANDAUE ) S.c.

AFFIDAVIT OF LOSS

I, JOYME T. HERRERA, of legal age, single, Filipino and a resident

of Panas, Consolacion, Cebu, after being sworn to in accordance with law,
depose and say that:

1. I was previously issued a Voter’s Identification Card by the

Commission on Election;

2. I used to keep the above-mentioned ID in my pocket;

3. About a week ago, while I was on my way home, I accidentally

left the said evidence of identity;

4. I tried all efforts to locate the misplaced ID but I was not able to
find it;

5. The said Voter’s Identification Card 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 31 st day

of December 2015, in the City of Mandaue, Philippines.

JOYME T. HERRERA
Affiant

JURAT

SUBSCRIBED and sworn to before me, this 31 st day of December

2015, in the City of Mandaue, affiant personally known to the undersigned
and the former exhibiting to the latter her Consolacion Multi-Purpose
Cooperative ID with number SL8855 and valid up to present.

Doc. No. ___;

Page No. ___;
Book No. ___;

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