REPUBLIC OF THE PHILIPPINES )

BINAN, LAGUNA )S.S.

AFFIDAVIT OF LOSS

I, ALICIA MARIE M. RIGONAN, of legal age, Filipino, and with residence address
at Blk. 10/2 Lot 3-A, Juana 3-C, San Francisco, Halang, Bian, Laguna, after having been duly
sworn to in accordance with law, do hereby depose and say:
1. That I am the holder a POSTAL I.D CARD issued at Post Office, Binan. Laguna;

2. That the said POSTAL I.D. CARD was lost in my possession without my knowledge;

3. That all effort was made to locate the said POSTAL I.D. CARD but prove futile and
vain;

4. That I executed this affidavit in order to attest to the truth of the foregoing facts and for
whatever purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of _______, 20__
at ___________.

ALICIA MARIE M. RIGONAN

Affiant

SUBSCRIBED AND SWORN to before me this __ day of __________, 20__ at

__________. Affiant exhibited to me his/her Identification No. ______________________

Doc. No.
Page No.
Book No.
Series of 2015