Professional Documents
Culture Documents
PROVINCE OF PANGASINAN
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CITY OF URDANETA
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SS.
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AFFIDAVIT OF LOSS
I, LAURETA IGNACIO, widow, of legal age, Filipino, and resident of
Brgy. Anonas, Urdaneta City, Pangasinan, under oath, depose and say that:
1. I am the surviving spouse of the late Pablo C. Ignacio who died on 6
December 1999;
A copy of the Death Certificate is attached hereto as Annex A and
made an integral part of this Affidavit.
2. My late husband Pablo C. Ignacio and I own a property located in
no avail;
6. That said loss was neither due to the confiscation nor mortgaged to
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SS.
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AFFIDAVIT OF LOSS
I, AMELIA DELA CRUZ FERNANDO, married, of legal age, Filipino, and
resident of _________________________________, under oath, depose and say;
that:
8. I graduated at the Far Eastern University in 1980 with the degree of
Doctor of Medicine;
9. I was issued a college diploma in my maiden name AMELIA AGAPITO
DELA CRUZ;
10. Lately, I discovered that my said Diploma is missing and despite
diligent efforts exerted in order to recover and locate the same but
all to no avail;
11. Said loss was not due to the confiscation, or cancellation thereof, nor
and for the purpose of securing another Diploma in lieu of the lost
one.
IN WITNESS HEREOF, I affixed my signature this 2nd day of June, 2008
in Urdaneta City.
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SS.
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AFFIDAVIT OF LOSS
WE, CARLOS T. AGBANLOG, widower, CHARLTON M. AGBANLOG, CARLOS M.
AGBANLOG II, CHRISTIAN
M. AGBANLOG, CHARLOTTE M. AGBANLOG, all legal age, Filipinos, and residents
of Bactad East, Urdaneta City, under oath, depose and say; that:
13.We are the legal heirs of the deceased HELEN MANAOIS AGBANLOG who
passed away on 12 November 2006 in Bactad East, Urdaneta City;
14.HELEN MANAOIS AGBANLOG was a member of the Philippine Public School
Teachers Association (PPSTA) since _________________________and was
issued a Policy Contract;
15.When preparing all the requirements to claim all receivable benefits of the
deceased HELEN MANAOIS AGBANLOG with the PPSTA, we discovered that
said Policy Contract is no longer intact;
16.We exerted diligent efforts to recover and locate the same but all to no
avail;
17.Said loss was not due to the confiscation, mortgage, or cancellation thereof
or whatsoever;
18.We are executing this affidavit to attest to the truth of the foregoing facts
for all legal intents and purposes.
IN WITNESS HEREOF, we afied our signatures this 5 th day of May, 2008 in
Urdaneta City.
CARLOS T. AGBANLOG
Affiant
Drivers License No. _____________
CHARLTON M. AGBANLOG,
Affiant
TIN No. 940-251-226
CARLOS M. AGBANLOG II
Affiant
Drivers License No. ____________
CHRISTIAN M. AGBANLOG
Affiant
Drivers License No. ____________
CHARLOTTE M. AGBANLOG
Affiant
Postal ID No. ________________
SUBSCRIBED AND SWORN to before me this 5 th day of May, 2008 in
Urdaneta City.
)SS.
AFFIDAVIT OF LOSS
I, ESPERANZA R. BIAGTAN, of legal age, widow, Filipino, and a resident
of #7 Rizal Ave. Mangaldan, Pangasinan, after having been duly sworn
to in accordance with law, do hereby depose and say:
1.
2.
3.
4.
5.
6.
7.
8.
the
confiscation
nor
DOMINICO A. SANCHEZ
Public Attorney II
Pursuant to RA 9406