REPUBLIC OF THE PHILIPPINES

PROVINCE OF BATANGAS
CITY OF TANAUAN

)
) S. S.
)

AFFIDAVIT OF LOSS
I, ALBERT S. RIBLEZA, 22 years old, single and a resident of Brgy.
Darasa, Tanauan City, Batangas, after having been sworn to in accordance
with law, hereby depose and say THAT:
1. I am presently employed in Walter Mart Tanauan City, Batangas
particularly in Supermarket section as Merchandiser;
2. On October 8, 2016 around 10:35 oclock in the evening, I was
performing my duty as such, thereafter when I went to the parking lot where
my motorcycle with plate No. DC10324 was parked;
3. Upon seeing my motorcycle I discovered the trunk of my motorcycle
was broken and I was robbed;
4. That contents of the trunk of my motorcycle that was taken are as
follows;
a. My voters ID;
b. My non-Professional Drivers License issued by Land Registration
Office (LTO) of San Pablo, Laguna;
c. My philhealth card;
d. Registration Receipt of Sticker of my motorcycle;
e. My wallet bearing amount of Php720.00;
f. My O plus Cellular Phone;
g. BDO Cash Card (ATM) of my partner, Shammah Jirah Atienza; and
h. Smart Money Card (ATM) of my partner, Shammah Jirah Atienza;
5. I already reported such fact to the authorities of Walter Mart. Thus, I
am certain that the foregoing items, IDs and cards enumerated above are
now stolen and beyond recovery;
6. I am executing this affidavit to attest to the truthfulness and
veracity of the foregoing statements, for the purpose of requesting for
issuance of new cards/IDs from enumerated concerned offices, respectively
and for whatever legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 10 th day of
October 2016 at Tanauan City, Batangas, Philippines.
ALBERT S. RIBLEZA
Affiant
SUBSCRIBED AND SWORN to before me this 10th day of October
2016 at Tanauan City, Batangas, Philippines, affiant exhibiting to me his
Voters Certification with number 1031-0197A-A0494ASR10000-6 bearing his
picture and signature to prove her identity.

HEART C. LERO
Public Attorney I
Pursuant to R.A. 9406