Republic of the Philippines)

City of Pasay ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS
I, Allan Joseph A. Rivas, of legal age, Filipino, single, and resident of Sun Valley NAIA, Pasay
City, after being duly sworn according to law, hereby depose and state that:

1. I am the holder of Philhealth ID issued by the Philippine Health Insurance Corporation.

2. Sometime in January 10 2018, I lost the above under the following circumstances: My wallet
containing my Philhealth ID was stolen under the skyway in Magallanes.

3. Despite diligent efforts exerted, I could no longer locate, find or recover the said Philhealth ID,
and to the best of my knowledge, the same is truly lost.

4. The said Philhealth ID has not been confiscated by any officer of the law or the issuing office
or agency due to the violation of any law, statute, order, rule or regulation.

5. In the event that the lost Philhealth ID should hereafter be found or located, I undertake to
forward or surrender the same to Philippine Health Insurance Corporation for appropriate
disposal.

6. I am executing this Affidavit to attest to the truth of the foregoing statements and to request
the issuance of a new PhilHealth ID in lieu of the one which was lost.

Allan Joseph A. Rivas

Affiant

Affiant SUBSCRIBED AND SWORN to before me this ____________________, affiant

exhibited to me his/her Competent Evidence of Identity by way of __________________ issued
at ______________ on __________________. Doc. No. ______; Page No. ______; Book No.
______; Series of ______.
Republic of the Philippines)

City of Pasay ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS
I, Allan Joseph A. Rivas, of legal age, Filipino, single, and resident of Sun Valley NAIA, Pasay
City, after being duly sworn according to law, hereby depose and state that:

1. I am the holder of PAGIBIG ID issued by the PAG-IBIG: Pagtutulungan sa Kinabukasan:

Ikaw, Bangko, Industria at Gobyerno.

2. Sometime in January 10 2018, I lost the above under the following circumstance: My wallet
containing my PAG IBIG ID was stolen under the skyway in Magallanes.

3. Despite diligent efforts exerted, I could no longer locate, find or recover the said PAGIBIG ID,
and to the best of my knowledge, the same is truly lost.

4. The said PAG IBIG ID has not been confiscated by any officer of the law or the issuing office
or agency due to the violation of any law, statute, order, rule or regulation.

5. In the event that the lost PAG IBIG ID should hereafter be found or located, I undertake to
forward or surrender the same to PAG-IBIG: Pagtutulungan sa Kinabukasan: Ikaw, Bangko,
Industria at Gobyerno.

for appropriate disposal.

6. I am executing this Affidavit to attest to the truth of the foregoing statements and to request
the issuance of a new PAG IBIG ID in lieu of the one which was lost.

Allan Joseph A. Rivas

Affiant

Affiant SUBSCRIBED AND SWORN to before me this ____________________, affiant

exhibited to me his/her Competent Evidence of Identity by way of __________________ issued
at ______________ on __________________. Doc. No. ______; Page No. ______; Book No.
______; Series of ______.
Republic of the Philippines)

City of Pasay ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS
I, Allan Joseph A. Rivas, of legal age, Filipino, single, and resident of Sun Valley NAIA, Pasay
City, after being duly sworn according to law, hereby depose and state that:

1. I am the holder of SSS ID issued by the Social Security System.

2. Sometime in January 10 2018, I lost the above under the following circumstances: My wallet
containing my SSS ID was stolen under the skyway in Magallanes.

3. Despite diligent efforts exerted, I could no longer locate, find or recover the said SSS ID, and
to the best of my knowledge, the same is truly lost.

4. The said SSS ID has not been confiscated by any officer of the law or the issuing office or
agency due to the violation of any law, statute, order, rule or regulation.

5. In the event that the lost SSS ID should hereafter be found or located, I undertake to forward
or surrender the same to Social Security System for appropriate disposal.

6. I am executing this Affidavit to attest to the truth of the foregoing statements and to request
the issuance of a new SSS ID in lieu of the one which was lost.

Allan Joseph A. Rivas

Affiant

Affiant SUBSCRIBED AND SWORN to before me this ____________________, affiant

exhibited to me his/her Competent Evidence of Identity by way of __________________ issued
at ______________ on __________________. Doc. No. ______; Page No. ______; Book No.
______; Series of ______.
Republic of the Philippines)

City of Pasay ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS
I, Allan Joseph A. Rivas, of legal age, Filipino, single, and resident of Sun Valley NAIA, Pasay
City, after being duly sworn according to law, hereby depose and state that:

1. I am the holder of Driver’s License issued by the Land Transportation Office.

2. Sometime in January 10 2018, I lost the above under the following circumstances: My wallet
containing my Driver’s License was stolen under the skyway in Magallanes.

3. Despite diligent efforts exerted, I could no longer locate, find or recover the said Driver’s
License, and to the best of my knowledge, the same is truly lost.

4. The said Driver’s License has not been confiscated by any officer of the law or the issuing
office or agency due to the violation of any law, statute, order, rule or regulation.

5. In the event that the lost Driver’s License should hereafter be found or located, I undertake to
forward or surrender the same to Land Transportation Office for appropriate disposal.

6. I am executing this Affidavit to attest to the truth of the foregoing statements and to request
the issuance of a new Driver’s License in lieu of the one which was lost.

Allan Joseph A. Rivas

Affiant

Affiant SUBSCRIBED AND SWORN to before me this ____________________, affiant

exhibited to me his/her Competent Evidence of Identity by way of __________________ issued
at ______________ on __________________. Doc. No. ______; Page No. ______; Book No.
______; Series of ______.
Republic of the Philippines)

City of Pasay ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS
I, Allan Joseph A. Rivas, of legal age, Filipino, single, and resident of Sun Valley NAIA, Pasay
City, after being duly sworn according to law, hereby depose and state that:

1. I am the holder of Tax Identification Number ID issued by the Bureau of Internal Revenue.

2. Sometime in January 10 2018, I lost the above under the following circumstances: My wallet
containing my Tax Identification Number ID was stolen under the skyway in Magallanes.

3. Despite diligent efforts exerted, I could no longer locate, find or recover the said Tax
Identification Number ID, and to the best of my knowledge, the same is truly lost.

4. The said Tax Identification Number ID has not been confiscated by any officer of the law or
the issuing office or agency due to the violation of any law, statute, order, rule or regulation.

5. In the event that the lost Tax Identification Number ID should hereafter be found or located, I
undertake to forward or surrender the same to Bureau of Internal Revenue for appropriate
disposal.

6. I am executing this Affidavit to attest to the truth of the foregoing statements and to request
the issuance of a new Tax Identification Number ID in lieu of the one which was lost.

Allan Joseph A. Rivas

Affiant

Affiant SUBSCRIBED AND SWORN to before me this ____________________, affiant

exhibited to me his/her Competent Evidence of Identity by way of __________________ issued
at ______________ on __________________. Doc. No. ______; Page No. ______; Book No.
______; Series of ______.