REPUBLIC OF THE PHILIPPINES )

CITY OF MANDAUE
) S.c.

AFFIDAVIT OF LOSS
I, JADE MARK V. MARIBOJO, of legal age, single, Filipino and a
resident of Sitio Lupa, Highway, Mandaue City, Cebu, after being sworn to
in accordance with law, depose and say that:
1.
2.
pocket;

I was previously issued a drivers license;

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

3.
About a week ago, while I was on my way home, I accidentally
left the said evidence of identity;
4.
find it;
5.

I tried all efforts to locate the misplaced ID but I was not able to
The drivers license 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 14 th day
of June 2016, in the City of Mandaue, Philippines.

JADE MARK V. MARIBOJO

Affiant
JURAT
SUBSCRIBED and sworn to before me, this 14th day of June 2016, in
the City of Mandaue, affiant personally known to the undersigned and
exhibited to me his Philippine Passport with number EC0002430 issued by
DFA- Cebu and valid up to 14 Jan 2019.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2016.
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