REPUBLIC OF THE PHILIPPINES)

: S.S.
CITY OF MANILA )
x-----------------------------------------------x

AFFIDAVIT OF LOSS

I, JENNER S. ALBERTO, of legal age, Filipino and a resident of

No. 532-B Ayala Boulevard, Ermita, Manila, after having duly sworn to in
accordance with law, do hereby depose and state:

1. That I am a holder of a Automated Teller Machine card duly issued

by the Metrobank with Account Number ________________;

2. That sometime on June 19, 2014, aforesaid ATM Card which was
placed inside my bag together with my other papers and few
amount of pesos was snatched by an unidentified snatcher while I
was in a jeepney in front of Manila City Hall going to Pier 15 North
Harbor. That I noticed the said loss when I was already in the
office;

3. That I exerted efforts on locating the same but proved negative

result and that the same is now beyond recovery;

4. That I am executing this Affidavit to attest to the truth of the

foregoing and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 27 th

day of June 2014 in the City of Manila.

JENNER SALVADOR ALBERTO

Affiant

SUBSCRIBED AND SWORN to before me this ___th day of ______ 2014

in the City of Manila.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.
REPUBLIC OF THE PHILIPPINES)
: S.S.
CITY OF MANILA )
x-----------------------------------------------x

AFFIDAVIT OF LOSS

I, NESTOR P. GOMEZ, of legal age, Filipino and a resident of No.

No. 156 m. Salvacion Street, San Juan, Metro Manila, after having duly
sworn to in accordance with law, do hereby depose and state :

1. That I am a holder of a Professional Driver’s License duly issued by the

Land Transportation Office, the same is to expire on October 6, 2005;

2. That sometime in April 5, 2005, aforesaid professional Driver’s License,

which was placed in my wallet together with its Official Receipt and other
documents and few amount of pesos was either lost or picked by an
unidentified pickpocket while I was on my way home from Greenhills
Supermarket. That I noticed the said loss when I was already at home;

3. That I exerted efforts on locating the same but proved negative result and
that the same is now beyond recovery. I undertake to notify the (LTO)
should the same be recovered;

4. That I am executing this Affidavit to attest to the truth of the foregoing and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 12 th

day of April 2005 in the City of Manila.

NESTOR P. GOMEZ
Affiant

SUBSCRIBED AND SWORN to before me this 12th day of April 2005 in

the City of Manila.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2005.

Republic of the Philippines )

CITY OF MANILA ) SS.

AFFIDAVIT OF LOSS

I, JOSELITO J. ACUÑA, 42 years of age, married and presently

residing at Brgy. Cabul-Anonan, Malitbog, Southern Leyte , after having
been duly sworn to in accordance with law, depose and state that:

1. I am a holder of a Liberian Seaman’s Book issued sometime in

1984;

2. I am intended to board a vessel MV Asia Rindo manned by

Baliwag Navigation, Inc.;

3. On 20 June 2004, I tried to locate said Liberian Seaman’s Book,

unfortunately the same is nowhere to be found;

4. Despite diligent effort to locate the aforementioned Seaman’s

Book, the same was futile and it is now considered lost;

5. I am executing this affidavit for the purpose of a re-issuance of

a new Seaman’s Book and to attest to the truthfulness of the foregoing
and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___

day of July 2004 in the City of Manila, Philippines.

JOSELITO J.
ACUÑA
Affiant

SUBSCRIBED AND SWORN to before me this __ day of July

2004 in the City of Manila, Philippines.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2004.

REPUBLIC OF THE PHILIPPINES)

: S.S.
CITY OF MANILA )
x---------------------------------------x

AFFIDAVIT OF LOSS

I, LUIS DELOS SANTOS ROBLES, of legal age, Filipino and

presently residing at No. 1284-A Burgos St., Paco, Manila, after
having sworn to in accordance with law, hereby deposes and says:

1. That I am a holder of a Professional Driver’s License with

License No. NO4-92-243111;

2. That on or about March 12, 2005, while on my way home

aboard a Public Utility Vehicle, I noticed that my wallet which was in
my pocket was missing. Said wallet contains cash, my driver’s
license and other valuables.

3. I took diligent effort to locate the same but it was futile as

such, it is now considered lost.

4. This Affidavit is being executed to attest to the foregoing

facts and for the re-issuance of my driver’s license for whatever legal
purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this 30th day of March, 2005 in the City of Manila, Philippines.

LUIS S. ROBLES
Affiant

SUBSCRIBED AND SWORN to before me this 30th day of

March 2005 in the City of Manila, Philippines.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2005.
REPUBLIC OF THE PHILIPPINES)
: S.S.
CITY OF MANILA )
x------------------------------------------------x

AFFIDAVIT OF LOSS

I, MA. ROSELLA A. ROSALES, of legal age, Filipino, single and presently

residing at No. 18 Chico Road, Pilar Village, Las Piñas City, after having sworn to in
accordance with law, hereby deposes and says:

1. That I am a holder of a Cebuana Lhuiller Las Piñas Branch Pawn Ticket with Receipt No.
062901 in the amount of P13,800.00, a necklace JI 30 grams pawned last March 22, 2004;

2. That on April 20, 2004, I tried to locate said Pawn Ticket unfortunately the same is
nowhere to be found;

3. That despite diligent effort to locate the aforementioned Pawn ticket, the same was futile
and it is now considered lost;

4. That this affidavit is being executed for the purpose of securing a copy of said ticket;

5. That I am executing this Affidavit to attest to the truth of the foregoing.

IN WITNESS WHEREOF , I have hereunto affixed my signature this 20th day of April
2004 in the City of Manila.

MA. ROSELLA R. ROSALES

Affiant

SUBSCRIBED AND SWORN to before me this _____ day of April 2004 in the City of
Manila.

Doc. No. _____;

Page No. _____;

Book No. _____;
Series of 2004.