Affidavit of Loss - SSS RECEIPT-SAMPLE

Republic of the Philippines)
AFFIDAVIT OF LOSS
I, MARIA LABINTA, of legal age, Filipino citizen, single and a resident of

_________________________, Philippines, after having duly sworn to in accordance
with law, do hereby depose and say:
1. That I am a member of Social Security Systems (SSS);
2. That I am paying my contributions at SSS;
3. That I had been issued a Receipt upon payment with Receipt Number: 919742 &
SBR date 01/18/2000 for the year 2000;
4. That unfortunately however, I misplaced my SSS Receipt somewhere in the house

sometimes on the year 2001;
5. That I exerted efforts to locate the said SSS Receipt, the same cannot be found;
6. That I now consider it lost and beyond recovery;
7. That I am executing this affidavit to attest the veracity of the foregoing facts and
for legal purposes and intents;
IN WITNESS WHEREOF, I have hereunto affix my signature on this

_____________________ at Balamban, Cebu, Philippines.
MARIA LABINTA
Affiant
VIN:
SUBSCRIBED AND SWORN to before me this ____________________ at

_______________________________
Doc. No. ________
Page No. ________
Book No. ________
Series of ________
Province of Cebu....………) S.S.
Municipality of Balamban )
AFFIDAVIT OF LOSS
I, MAYBELLINE S. CONDE, of legal age, Filipino citizen, married and a

resident of Buanoy, Balamban, Cebu, Philippines, after having duly sworn to in
accordance with law, do hereby depose and say:
8. That I had successfully passed the licensure examination for Nurses sometime in
2007 that was conducted by Philippine Regulation Commission (PRC);
9. That I had been issued a PRC Board Certification upon passing the Board
Examination;
10. That unfortunately however, I misplaced the said PRC Board Certification
somewhere in our house after our house was hit by typhoon Yolanda;
11. That I exerted efforts to locate the said PRC Board Certification, the same cannot
be found;
14. Further deposed sayeth none.

MAYBELLINE S. CONDE
Affiant
PRC Reg. No. 0472159

Balamban, Cebu.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2018
AFFIDAVIT OF LOSS
I, CRESANTO SARONA, of legal age, Filipino citizen, single and a resident of

Combado, Cantuod, Balamban, Cebu, Philippines, after having duly sworn to in
15. That I am an employee of CMI Marine Services, assigned at Tsuneishi Heavy

Industries, (Cebu) Inc. Buanoy, Balamban, Cebu;
16. That I had been issued a Emergency hire ID by said company;
17. That on June 2016, I lost the said ID somewhere inside my house;
18. That inspite of my efforts to locate the said ID, the same cannot be found;

CRESANTO SARONA
Affiant

Balamban, Cebu.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2016
AFFIDAVIT OF LOSS
I, ROSADELIMA O. TAN, of legal age, Filipino citizen, married and a resident

of Abucayan, Balamban, , Cebu, Philippines, after having duly sworn to in accordance
22. That I am the proprietor/manager of LIMA’s Canteen;
23. That I on June 25, 2011, I collected the ID’s of my employees whose names are
listed below for renewal at THICI;
2.1 _______________________________
2.2. _______________________________
2.3 _______________________________
2.4 _______________________________
2.5 _______________________________
2.6 _______________________________
2.7 _______________________________
2.8 _______________________________
2.9 _______________________________
2.10_______________________________
24. That unfortunately however, I misplaced the plastic bag which contain the
Identification Cards of my employees;
25. That inspite of my efforts to locate the said plastic bags with the IDs, the same
cannot be found;

ROSADELIMA O. TAN
Affiant
SUBSCRIBED AND SWORN to before me this ________________________ at

Balamban, Cebu, Philippines, affiant exhibiting to me her Community Tax Certificate
No. ________________ issued on ______________________ at___________________
Cebu, Philippines.
Doc. No. ________

Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, GENEROSO M. CANASA, JR., of legal age, Filipino citizen, married and a

resident of San Isidro, Asturias, Cebu, Philippines, after having duly sworn to in
29. That I am an employee of TSUNETETSU CEBU INC., assigned at of Tsuneishi

Heavy Industries, (Cebu) Inc. Buanoy, Balamban, Cebu;
30. That I had been issued a TSUNETETSU CEBU INC. ID and CIPDI ID by said
company;
31. That on June 19, 2011, I lost the said IDs while I was inside THICI premises
carrying out my normal duties and responsibilities;
32. That inspite of my efforts to locate the said IDs, the same cannot be found;

GENEROSO M. CANASA, JR
Affiant

Balamban, Cebu, Philippines, affiant exhibiting to me his Community Tax Certificate
No. ________________ issued on ______________________ at___________________
Cebu, Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, FEBIE O. AÑOSA, of legal age, Filipino citizen, single and a resident of

Calag-itan Buanoy, Balamban, , Cebu, Philippines, after having duly sworn to in
36. That I am an employee of ASIAN SKILLED HUMAN NETWORK, INC.

(ASHNI) a subcontractor of TCI assigned at Tsuneishi Heavy Industries, (Cebu)
Inc. Buanoy, Balamban, Cebu;
37. That I had been issued a ASHNI ID by said company;
38. That on June 13, 2011, I lost my ASHNI ID when I was on my way home from
work at THICI, Buanoy, Balamban, Cebu;

FEBIE O. AÑOSA
Affiant

No. 27082435 issued on June 16, 2011 at Balamban, Cebu, Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, ROLANDO T. BOOC, of legal age, Filipino citizen, married and a resident of

Arpili, Balamban, , Cebu, Philippines, after having duly sworn to in accordance with law,
do hereby depose and say:
1. That I am the son of the late BONIFACIO T. BOOC;
2. That my late father was a member of Balamban Municipal Federation of Senior

Citizens, Inc. and was issued a Senior Citizen ID by the said association;
3. That unfortunately after the death of my father, BONIFACIO T. BOOC on June

8, 2011, I can no longer locate his Senior Citizen ID;

ROLANDO T. BOOC
Affiant

No. 27016428 issued on April 7, 2011 at Balamban, Cebu, Philippines.
Doc. No. _________
Page No. _________
Book No. _________
Series of 2011.
AFFIDAVIT OF NO LOSS OF TITLE OF LOT NO. 4619
I, FELISA D. DINAWANAO, of legal age, Filipino citizen, married and a

resident of Cambuhawe, Balamban, , Cebu, Philippines, after having duly sworn to in
8. That I am the granddaughter of Feliciano Dayanan, who was a resident of

Lamesa, Balamban, Cebu;
9. That our late grandfather bought a parcel of land bearing Lot No. 4619 with an
area of 38,614 sq.m. from the late Dionisio Villaviles on June 7, 1936;
10. That the Original Certificate of Title of Lot No. 4619 bearing No. RO-3460(0-
33101) is in my possession having hand over to me by my parents who inherited
the above parcel of land;
11. That the ORIGINAL CERTIFICATE OF TITLE is NEVER BEEN LOST since I
kept hold of it including documents signifying the sale of the above parcel of land
in favor of our grandfather;
12. That I execute this AFFIDAVIT OF NO LOSS OF TITLE OF LOT NO. 4619 to
attest the veracity of the foregoing facts and for legal purposes and intents;

FELISA D. DINAWANAO
Affiant

No.27081204 issued on June 6, 2011 at Balamban, Cebu, Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, SUSAN C. TRIBUNALO, of legal age, Filipino citizen, married and a resident

of Pondol, Balamban, , Cebu, Philippines, after having duly sworn to in accordance with
law, do hereby depose and say:
14. That sometime in December 2010, my son RICHARD C. TRIBUNALO bought a

Neo Laptop Computer Model No. MIIIO with S/N: NKM1110QC000J04852 and
was given to me as his Christmas Gift from Silicon Valley Computer shop, at SM
Cebu City;
15. I he handed to me the Official Receipt of said computer;
16. That unfortunately however, I misplaced the said receipt somewhere in our house;
17. That inspite of my efforts to locate the said Official Receipt, the same cannot be
found;

SUSAN C.
TRIBUNALO Affiant

No. ________________ issued on ______________________ at Balamban, Cebu,
Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, JEFFREY D. CURAZA, of legal age, Filipino citizen, married and a resident

of Abucayan, Balamban, , Cebu, Philippines, after having duly sworn to in accordance
21. That I am an employee of JEC METAL WORKS, a subcontractor of Tsuneishi

22. That I had been issued a CIPDI ID by said company;
23. That on May 26, 2011, I lost the said ID when I was on my way home from work
at THICI, Buanoy, Balamban, Cebu;

JEFFREY D. CURAZA
Affiant

No. ________________ issued on ______________________ at___________________
Cebu, Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, PEDMAR N. EROY, of legal age, Filipino citizen, single and a resident of

Arpili, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
1. That I am an employee of Metaphil International , a subcontractor of Tsuneishi

2. That I had been issued a Company ID by said company;
3. That on July 7, 2011, I lost the said ID while I was on my way home from work at
THICI at Buanoy, Balamban, Cebu;

PEDMAR N. EROY
Affiant

No. ____________________ on ________________ at Balamban, Cebu, Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, WARREN S. DEMETRIA, of legal age, Filipino citizen, married and a

resident of Cambuhawe, Balamban, Cebu, Philippines, after having duly sworn to in
8. That I am a public school teacher and a holder of Universal Multi-Purpose ID

issued by GSIS;
9. That on sometime in December 2010, I lost the said UMID when I was on board a
V-Hire from Cebu City going to Balamban, Cebu;

WARREN S. DEMETRIA
Affiant

No. ____________________ issued on _____________________ at Balamban, Cebu,
Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, JAYLORD G. TUMAYAW, of legal age, Filipino citizen, married and a

resident of Pondol, Balamban, Cebu, Philippines, after having duly sworn to in
14. That I am an employee of ROVER MARINE SERVICES;
15. That I had been issued an ID by said company;
16. That on April 1, 2011, I lost my Company ID somewhere inside the THICI,
Buanoy, Balamban, Cebu;

JAYLORD G. TUMAYAW
Affiant

No. ____________________ issued on _____________________ at Balamban, Cebu,
Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
Province/City of Cebu....…) S.S.
AFFIDAVIT OF LOSS
I, IRNA J. RECIMIENTO, of legal age, Filipino citizen, married and a resident

of Langub, Asturias, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am a Franchise Dealer of AVON Cosmetics, Inc.;
2. That I have been issued an ID by the said company;
3. That sometime in January 2011, I lost the said AVON ID while I was at Asturias
Public Market, Asturias, Cebu;
4. That I exerted efforts to locate the said ID, but my efforts turned futile,
consequently, I now consider it lost and beyond recovery;
5. That I am executing this affidavit to attest the veracity of the foregoing facts, to
support my intention to get a new ID and for legal purposes and intents.

_____________________ at _________________, Cebu.
IRNA J. RECIMIENTO
Affiant
SUBSCRIBED AND SWORN to before me this _________________________

affiant exhibiting to me her Community Tax Certificate No. 13046555 issued on January
7, 2011 in Asturias, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, JEFFREY D. CURAZA, of legal age, Filipino citizen, and a resident of

Balamban, Cebu, Philippines, after having duly sworn to in accordance with law, do
hereby depose and say:
1. That I am an employee of JEC Metal Works assigned at Tsuneishi Heavy

Industries (Cebu), Inc. Buanoy, Balamban, Cebu;
2. That I have been issued an ID by the said company as well as CIPDI and RF ID
by THICI;
3. That on May 26, 2011, I lost my JEC ID, CIPDI ID and RF ID while I was on my
way home from work at THICI at Buanoy, Balamban, Cebu;
4. That I exerted efforts to locate the said IDs, but my efforts turned futile,
5. That I am executing this affidavit to attest the veracity of the foregoing facts, to
support my intention to get new IDs and for legal purposes and intents.

_____________________ at Balamban, Cebu.
JEFFREY D. CURAZA
Affiant

affiant exhibiting to me his Community Tax Certificate No. _________________issued
on _________________in ______________, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, MARWEL C. LLENO, of legal age Filipino citizen, and a resident of Pondol,

1. That I am a 2nd year Industrial Engineering student of Cebu Institute of

Technology;
2. That I had been issued a School ID by said university;
3. That on April 2011. I lost or misplaced the said ID somewhere inside our House
at Pondol, Balamban, Cebu;
4. That I exerted efforts to locate for the said School ID, but my efforts turned futile;
5. I now consider it lost and beyond recovery;
for legal purposes and intents.
IN WITNESS WHEREOF, I have hereunto affixed my signature on this

_____________________ at Balamban, Cebu.
MARWEL C. LLENO
Affiant
SUBSCRIBED AND SWORN to before me this _____________________

affiant exhibiting to me her Community Tax Certificate No. ____________issued on
____________ at __________, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, LORE MAE C. ESDRELON of legal age, Filipino citizen, single and a resident
of Buanoy, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
21. That I am an On-Job-Trainee of Metaphil International, Inc., a subcontractor of

THICI, Buanoy, Balamban, Cebu;
22. That I prepared the invoices used for billing our clients;
23. That unfortunately however, the invoice bearing No. 7321 which is for the billing
of rental of laydown area for the period covered from October 23, 2009 up to
October 30, 2009, in the amount of Twenty Six Thousand Six Hundred Ten Pesos
and Ninety Three Centavos billed to Steel Processing Department of THICI has
been misplaced somewhere in our office;
24. That inspite of my efforts to locate the said Invoice, the same cannot be found,

_____________________ at Balamban, Cebu.
RIZZA SEMBLANTE
Affiant

affiant exhibiting to me her Community Tax Certificate No. _________________ issued
on _______________________ at ______________________, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, GLENFORD B. INAHID, of legal age, Filipino citizen, single and a resident of

Prenza, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
1. That I am On-Job Trainee of RENS Marine Services, a subcontractor of THICI,

2. That on April 20, 2011, I lost my RENS Temporary ID, when I was on my way
home from work at THICI;
3. That inspite of my efforts to locate the said ID, the same cannot be found,

_____________________ at Balamban, Cebu.
GLENFORD B. INAHID
Affiant

affiant exhibiting to me his Community Tax Certificate No. _________________ issued
on _______________________ at Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, FERDINAND A. MANDAYA. of legal age, Filipino citizen, single and a

resident of Matab-ang, Toledo City, Cebu, Philippines, after having duly sworn to in
1. That I am a Mariner by profession and a holder of Seaman’s Book issued on April

26, 2009, by MARINA, Cebu City;
2. That unfortunately however, I lost my Seaman’s Book which was placed inside
my file folder last January 31, 2011, while I was on board a V-Hire from Cebu
City to my residence in Matab-ang, Toledo City;
3. That I believe that it fell off from my file folder unnoticed;
4. That I exerted efforts to locate for the said Seaman’s Book but to no avail,
for all other legal purposes and intents;

_____________________ at Balamban, Cebu.
FERDINAND A. MANDAYA
Affiant

affiant exhibiting to me his Community Tax Certificate No. _____________ issued on
_____________in __________________, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, CHIRRY ANN Y. BAZAR, of legal age, Filipino citizen, single and a resident
of Sta. Cruz, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
6. That I am an employee of Pacifica Agrivit Supplies, Inc., presently assigned at

Balamban, Cebu;
7. That our company purchased items from Consumer Trend under Invoice No.
and corresponding amount listed below:
2.1 Invoice No. 856 - P 58,220.00

2.2. Invoice No. 843 - P 34,050.00
2.3. Invoice No. 830 - P 67,675.00
2.4. Invoice No. 860 - P 21,950.00
8. That the said invoices are kept in our file folder;
9. That when I check the said file folder, the above stated invoices are no longer in
the file folder;
10. That inspite of my efforts to locate the said invoices, the same cannot be found,

_____________________ at Balamban, Cebu.
CHIRRY ANN T. BAZAR

Affiant
TIN : 273-742-310-000

affiant exhibiting to me her identification above-indicated.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, JAYNIÑA R. ESCOBA, of legal age, Filipino citizen, single and a resident of

Aliwanay, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
13. That I am an employee of Prime Asia Pawn & Jewelry Shop, Inc. – Balamban II
Branch;
15. That on January 14, 2011, I unknowingly dropped my ID when I was on board a
trisikad from our shop to our residence;

_____________________ at Balamban, Cebu.
JAYNIÑA R. ESCOBA
Affiant

January , 2011 in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, MATEO C. BRIGOLA, JR., of legal age, Filipino citizen, married and a

resident of Cantuod, Balamban, Cebu, Philippines, after having duly sworn to in
27. That I am a Trisikad driver;
28. That I had been issued an Trisikad ID Card;
29. That unfortunately however, my Trisikad ID which was hang inside my trisikad
fell to the ground unnoticed sometime late December 2010;

MATEO C. BRIGOLA, JR
Affiant

No. ____________________ issued on _____________________ at ____________
Cebu, Philippines.
AFFIDAVIT OF LOSS
I, ZENAIDA SEMBRA YNTIG, of legal age, Filipino citizen, married and a

34. That on January 14, 2011, I went to Cebu City to watch the forthcoming Sinulog
Gaisano Metro Plaza, Toledo City to buy some groceries for my family;
35. That I parked my motorcycle at the Mall’s parking area and left my bag hanging
on the handle bar of motorcycle;
36. That when I went back to my motorcycle, I noticed that my bag was no longer
hanging on the handle bar of my motorcycle;
37. That said bag contain my ACGI - Metaphil Division ID, THICI RF ID, hard hat
and uniform;
38. That inspite of my efforts to locate the said bag with all its contents, the same
cannot be found;

DIONISIO M. LAZAGA
Affiant

No. ____________________ issued on _____________________ at ____________
Cebu, Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, DIONISIO M. LAZAGA, of legal age, Filipino citizen, married and a resident

of Cambang-og, Toledo City, Cebu, Philippines, after having duly sworn to in accordance
42. That on January 13, 2011, I went to Gaisano Metro Plaza, Toledo City to buy
some groceries for my family;
43. That I parked my motorcycle at the Mall’s parking area and left my bag hanging
on the handle bar of motorcycle;
44. That when I went back to my motorcycle, I noticed that my bag was no longer
hanging on the handle bar of my motorcycle;
45. That said bag contain my ACGI - Metaphil Division ID, THICI RF ID, hard hat
and uniform;
46. That inspite of my efforts to locate the said bag with all its contents, the same
cannot be found;

DIONISIO M. LAZAGA
Affiant

No. ____________________ issued on _____________________ at ____________
Cebu, Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, HENRIQUE VINCENT NIÑO P. YPON Filipino citizen, single, 8 years old

and a resident of Arpili, Balamban, Cebu, Philippines, after having duly sworn to in
1. That I am a Grade III pupil of University of San Jose Recoletos – Balamban,

Campus;
2. That I had been issued an ID by said university;
3. That sometime in the month of March 2010, I unknowing dropped my USJR ID

which was hang around my neck when I was on my way home from school;
4. That I exerted efforts to locate the said ID, but my efforts turned futile,

_____________________ at Balamban, Cebu.
HENRIQUE VINCENT NIÑO P. YPON

Affiant
With guardian’s consent and conformity:
ROSITA PAULIN
Guardian
SUBSCRIBED AND SWORN to before me this _____________________ at

Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
juRepublic of the Philippines)
AFFIDAVIT OF LOSS
I, RONALD B. ALFECHE of legal age, Filipino citizen, single and a resident of

Buanoy, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of MOROMI MARINE SERVICES, a subcontractor of

2. That on March 14, 2011, I unknowingly dropped my company ID, RF and

CIPDI ID’s when I was working at THICI;
3. That inspite of my efforts to locate the said IDs, the same cannot be found,

_____________________ at Balamban, Cebu.
RONALD B. ALFECHE
Affiant

affiant exhibiting to me his Community Tax Certificate No. ______________ issued on
______________________at Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
Province of Cebu.....………) S.S.
AFFIDAVIT OF LOSS
I, REY M. GILAMON, Filipino citizen, of legal age, single and a resident of

Cambuhawe, Balamban, Cebu, Philippines, after having duly sworn to in accordance
1. That I graduated from Jose Chona Joy National High School last School Year
2004 - 2005;
2. That I had been issued a Diploma upon graduation;
3. That unfortunately however, I inadvertently misplaced the said Diploma

somewhere in our house;
4. That I exerted efforts to locate for the said Diploma, but to no avail, consequently
in now consider it lost and beyond recovery;

________________________ at Balamban, Cebu.
REY M. GILAMON
Affiant

No. _________________ issued on ___________________ at Balamban, Cebu,
Philippines.
Doc. No. _____

Page No. _____
Book No. _____
Series of 2010.
AFFIDAVIT OF LOSS
I, CHRISTIAN O. UGDAMEN, of legal age, Filipino citizen, single and a

resident of Arpili, Balamban, Cebu, Philippines, after having duly sworn to in accordance
1. That I am an employee of X’FORMERS assigned at THICI, Buanoy,

Balamban, Cebu;
2. That I had been issued a Temporary ID by said company;
4. That I am executing this affidavit to attest the veracity of the foregoing facts
and for legal purposes and intents.

_____________________ at Balamban, Cebu.
CHRISTIAN O. UGDAMEN
Affiant

_________________ in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, JASLIE D. SARSOZO, of legal age, Filipino citizen, married and a resident of

San Isidro, Asturias, Cebu, Philippines, after having duly sworn to in accordance with
1. That on March 10, 2011, I lost my wallet while I was onboard a tricycle from
Balamban Public Market, Balamban, Cebu going to Asturias, Cebu;
2. That said wallet contain among others, my Social Security Systems (SSS) ID,
Voter’s ID and Philheatlh Card;
3. That inspite of my efforts to locate the said wallet with all its contents, the same
cannot be found, consequently, I now consider it lost and beyond recovery;

_____________________ at Balamban, Cebu.
JASLIE D. SARSOZO
Affiant

affiant exhibiting to me his Community Tax Certificate No. _______________ issued on
_________________ in ________________, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
Province/City of Cebu …..) S.S.
AFFIDAVIT OF LOSS
I, VILMA A. ANGCOS, of legal age, Filipino citizen, single and a resident of

6. That I am an employee of MACTAN APPAREL INC. situated at Lapu-lapu,

Cebu City;
7. That on March 5, 2010, I unknowingly dropped my MACTAN APPAREL INC

ID when I was on my way home from work;

_____________________ at ____________________, Cebu.
VILMA A. ANGCOS
Affiant

affiant exhibiting to me her Community Tax Certificate No. ___________ issued on
________________________in______________, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, JOANICE N. NAVARES, of legal age, Filipino citizen, married and a resident

of Carcar City, Cebu, Philippines, after having duly sworn to in accordance with law, do
1. That on February 6, 2011, I lost my wallet while I was at Carcar Public Market,
Carcar City;
2. That said wallet contain among others my RCBC ATM Card and Philhealth Card;
3. That inspite of my efforts to locate the said wallet with my ATM Card and
Philhealth Card, the same cannot be found;

_____________________ at Balamban, Cebu.
JOANICE N. NAVARES
Affiant

__________________ at ____________________Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011
AFFIDAVIT OF LOSS
I, RONALD B. FERNANDEZ, of legal age, Filipino citizen, married and a

resident of Asturias, Cebu, Philippines, after having duly sworn to in accordance with
11. That I was as student of Cebu Technological Sciences, (CTS) Cebu City;
12. That I graduated last SY 2000 – 2001 with the degree in Electronic Technology;
13. That unfortunately however, the ID that was issued by the said school to me was
inadvertently misplaced somewhere in our house;

_____________________ at Balamban, Cebu.
RONALD B. FERNANDEZ
Affiant

___________________ at Asturias, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, REYNALDE O. SIMACAS, of legal age, Filipino citizen, married and a

resident of Cantibas, Balamban, Cebu, Philippines, after having duly sworn to in
17. That I am an employee of MOROMI MARINE SERVICES assigned at THICI,

18. That on February 22, 2010, I unknowingly dropped my MOROMI ID when I was
on my way home from work;

_____________________ at Balamban, Cebu.
REYNALDE O. SIMACAS
Affiant

affiant exhibiting to me his Community Tax Certificate No. 20659856 issued on January
21, 2010 in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, TEOFILO JR. M. BATULAN, Filipino citizen, of legal age, married and a

resident of Looc Norte, Asturias, Cebu, Philippines, after having duly sworn to in
1. That I am a member of Social Security Systems (SSS);
2. That I had been issued an ID by the said agency;
3. That unfortunately however, I lost my SSS ID which was placed in the envelope
containing my files last February 15, 2010 when I was at Cebu City processing
my pertinent papers to work abroad;

_____________________ at Balamban, Cebu.
TEOFILO JR. M. BATULAN

Affiant

affiant exhibiting to me his Community Tax Certificate No. ____________ issued on
____________in ________________Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, GENESIS C. MOSQUITE, Filipino citizen, of legal age, single and a resident

of Asturias, Cebu, Philippines, after having duly sworn to in accordance with law, do
7. That I am a On-Job-Trainee of AR Marine Subcon Services assigned at THICI,

9. That I inadvertently dropped the said ID when I was on my way home from work
last February 9, 2010;

_____________________ at Balamban, Cebu.
GENESIS C. MOSQUITE
Affiant

____________in ________________Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, RONIE A. CERAS, of legal age, Filipino citizen, married and a resident of

Cantuod, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am a JOB ORDER employee of Local Government Unit (LGU) of

Municipality of Balamban, Cebu;
2. That I had been issued an ID by HRD Department of LGU Balamban, Cebu;
3. That sometime in December 2009, while we were going to Luca, Balamban, Cebu
to pick up residents who will attend the burial onboard a dump truck, I noticed
that my ID was no longer pinned/clipped on my shirt;

_____________________ at Balamban, Cebu.
RONIE A. CERAS
Affiant

25, 2010 at Balamban, Cebu, Philippines.
AFFIDAVIT OF LOSS
I, JASON A. BULAWAN, of legal age, Filipino citizen, single and a resident of

Uling, Naga City, Cebu, Philippines, after having duly sworn to in accordance with law,
50. That I am an employee of ACGI - Metaphil Division, assigned at THICI,

52. That on January 3, 2011, I lost my company ID which was placed in my back
pocket when I was on my way home from work at THICI to my rented room in
Segra Buanoy, Balamban, Cebu;

JASON A. BULAWAN
Affiant

No. ____________________ issued on _____________________ at ____________
Cebu, Philippines.
Doc. No. ________
Page No. ________
Book No. ________
Series of 2011.
AFFIDAVIT OF LOSS
I, IWIEN GOC-ONG of legal age, Filipino citizen, single and a resident of Sto,
Niño, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
1. That I am an employee of PEVMAR assigned at THICI, Buanoy, Balamban,

Cebu;
2. That on January 12, 2011, I unknowingly dropped my THICI RF ID,

somewhere in Buanoy, Balamban, Cebu when I was on my home from work
at THICI;
3. That inspite of my efforts to locate the said RF ID, the same cannot be found,

_____________________ at Balamban, Cebu.
IWIEN GOC-ONG
Affiant

____________ at Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
Province of Cebu ) S.S.
AFFIDAVIT OF LOSS
I, ANAROS CANO-OG, Filipino citizen, of legal age, single and a resident of

Lamesa, Balamban, Cebui, Philippines, after having duly sworn to in accordance with
1. That I am a fourth year college student of Cebu Normal University – Balamban

Campus;
2. That I have my practicum teaching at Cebu Normal University Main Campus,

Cebu City;
3. That on November 3, 2009, after my practicum class, I went to Cebu South Bus
Terminal to catch a V-Hire bound to Balamban, Cebu;
4. That upon reaching home, I noticed that my school ID was no longer in my bag;
5. That I exerted efforts to locate the said ID but turned futile, consequently, I now
consider it lost and beyond recovery;

________________________ at Cebu City.
ANAROS CANO-OG
Affiant

No. 07673387 issued on November 9, 2009 at Balamban, Cebu, Philippines.
Doc. No. _____

Page No. _____
Book No. _____
Series of 2009.
AFFIDAVIT OF LOSS
I, JACOB N. ONDRAY, of legal age, Filipino citizen, single and a resident of

Pondol, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
1. That I am an employee of STARWELL MARINE SERVICES, a subcontractor of

2. That on March 16, 2011, I unknowingly dropped my Starwell ID somewhere

inside THICI premises while I was on my active duty;

_____________________ at Balamban, Cebu.
JACOB N. ONDRAY
Affiant

affiant exhibiting to me his Community Tax Certificate No. __________________
issued on March 16, 2011 at Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, BIENVENIDO T. TURTUR, of legal age, Filipino citizen, married and a

1. That I am an employee of AFB Manpower Services, assigned at THICI, Buanoy,

Balamban, Cebu;
2. That I had been issued an ID by said company and an RF ID by THICI;
3. That unfortunately however, I dropped the said IDS which was placed at the back
pocket of my pants last February 10, 2011 while I was my way to work at THICI;

_____________________ at Balamban, Cebu.
BIENVENIDO T. TURTUR
Affiant

affiant exhibiting to me his Community Tax Certificate No. 13133051 issued on February
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, MA. HELEN F. MANIGOS, of legal age, Filipino citizen, married and a

resident of Prenza, Balamban, Cebu, Philippines, after having duly sworn to in
1. That I am a client of Allied Bank of the Philippines – Mandaue Branch;
2. That I had been issued an ATM Card by the said bank
3. That on December 7, 2009, I unknowingly dropped my wallet which contain my

Allied Bank ATM Card somewhere in the Balamban Public Market, Balamban,
Cebu;
4. That I exerted extra efforts to locate the said wallet with my ATM Card, but the
same cannot be found;

_____________________ at Balamban, Cebu.
MA. HELEN F. MANIGOS

Affiant

affiant exhibiting to me her Community Tax Certificate No. 07673154 issued on October
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
Province/City of Cebu….…) S.S.
AFFIDAVIT OF LOSS
I, ANTONIA G. ENCABO. of legal age, Filipino citizen, a resident of Bago,

Asturias, Cebu, Philippines, after having duly sworn to in accordance with law, do hereby
depose and say:
1. That I and my late husband were owners of a parcel of land bearing Lot No. K of
the subdivision plan, BSD-07-01-005849 OLT being a portion of Lot 9, II-4933
covered by Transfer Certificate of Title No. 367, situated in Bago, Asturias,
Cebu;
2. That the Transfer Certificate of Title bearing No. 367 that was issued to us was
inadvertently misplaced somewhere in our house;
3. That inspite of my efforts to locate the said Transfer Certificate of Title, the
same cannot be found, consequently, I now consider it lost and beyond recovery;
Further deposed sayeth none.

_____________________ at Cebu City; Philippines.
ANTONIA G. ENCABO
Affiant

affiant exhibiting to me her Community Tax Certificate No. _________________issued
on ___________________ in Asturias, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of ______
AFFIDAVIT OF LOSS
I, RONALD P. FAJARDO, of legal age, Filipino citizen, married and a resident

of Abucayan, Balamban, Cebu, Philippines, after having duly sworn to in accordance
1. That I am an employee of FUNCTIONAL INC - CEBU BRANCH assigned at

Tsuneishi Heavy Industries (Cebu) Inc., Buanoy, Balamban, Cebu;
2. That unfortunately however, I dropped my FUNCTIONAL INC. ID when I was


_____________________ at Balamban, Cebu.
RONALD P. FAJARDO
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, EDUVEGIS C. ALIPIO, of legal age, Filipino citizen, married and a resident of

Matab-ang, Toledo City, Philippines, after having duly sworn to in accordance with law,
1. That on November 9, 2009, I unknowingly dropped my wallet which was placed

inside the back pocket of my pants which contain among others my Professional
Driver’s License, SSS ID, HSBC Credit Card, Equitable Bank ATM Card and
X’Formers ID Card when I was onboard my motorcycle going back home from
work at THICI at Buanoy, Balamban, Cebu;
2. That I exerted extra efforts to locate the said wallet with all its contents, but the
same cannot be found;
4. That my driver’s license has not been confiscated by police authority or traffic
officer for any traffic violations;

_____________________ at Balamban, Cebu.
EDUVEGIS C. ALIPIO
Affiant

affiant exhibiting to me his Community Tax Certificate No. 07675871 issued on
November 10, 2009 at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
Province of Cebu ..........…) S.S.
AFFIDAVIT OF LOSS
I, ROQUESA V. SOLIS, of legal age, Filipino citizen, widow and a resident of

San Roque, Asturias, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am a public school teacher and a member of Manila Teachers Mutual Aid
System. (MTMAS);
2. That I had been issued a Membership Certificate by the said Association;
3. That unfortunately however, I misplaced my Membership Certificate somewhere

inside our house at San Roque, Asturias, Cebu;
4. That I exerted efforts to locate the said Membership Certificate but my efforts
turned futile, consequently, I now consider it lost and beyond recovery;

_____________________ at Balamban, Cebu, Philippines..
ROQUESA V. SOLIS
Affiant

affiant exhibiting to me her Community Tax Certificate No. 13046638 issued on January
11, 2011 at Asturias, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, JAY B. HERMOSILLA, of legal age, Filipino citizen, married and a resident of

1. That I am an employee of Metaphil International, Inc., a subcontractor of THICI,

2. That I had been issued an ID by MI Inc.;
3. That unfortunately however, I dropped the said ID unnoticed while I was inside
THICI premises carrying out my duties last April 13, 2011;

_____________________ at Balamban, Cebu.
JAY B. HERMOSILLA
Affiant

________________ at ___________________, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, MARILYN M. LESMES, of legal age, Filipino citizen, widow and a resident of

1. That on September 6, 2009 at around 3:00 o’clock in the morning, our house was
caught in a fire;
2. That I made efforts to save our belongings and all pertinent documents but was
not able to do so because of shock and unbearable heat due to fire;
3. That our house and all my belongings were burn down during the blaze which
include among others my Green Bank Passbook, City Savings, PNB Bankbook
Voter’s ID, Postal ID, Driver’s License, Passport, SSS ID, Philhealth, BIR,
Certificates from National Statistics Office for me and for my children, IDs of my
children and other pertinent documents;
4. That my driver’s license was not confiscated by Traffic Officer and/or Police
Officer for traffic violation;

_____________________ at Balamban, Cebu.
MARILYN M. LESMES
Affiant

affiant exhibiting to me her Community Tax Certificate No. ________________ issued
on ___________________ at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, RIEL M. ATIS, of legal age, Filipino citizen, married and a resident of Biasong,
7. That I am an employee of BK3 assigned at Tsuneishi Heavy Industries (Cebu),

Inc. (THICI) at Buanoy, Balamban, Cebu;
8. That on August 12, 2009, I lost my BK3 ID when I was on my way home from
work at THICI;
9. That in spite of my efforts to locate the said ID, the same cannot be found;

_____________________ at Balamban, Cebu.
RIEL M. ATIS
Affiant

affiant exhibiting to me his Community Tax Certificate No. 00936536 issued on April 3,
2009 at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
City of Cebu...........………) S.S.
AFFIDAVIT OF LOSS
I, RUBY ROSE D. ROBLES, Filipino citizen, of legal age, and a resident of

Poblacion, Asturias, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am a fourth year college student at the Cebu Doctor’s University –

Medicine Department, Cebu City;
2. That I had been issued a School ID by the said university;
3. That unfortunately however, I lost my ID sometime last March 2010 when I was
on my home from school;
4. That I exerted efforts to locate the said ID but turned futile, consequently, I now

________________________ at Cebu City.
RUBY ROSE D. ROBLES

Affiant

No. ______________ issued on ________________ at _________________, Philippines.
Doc. No. _____

Page No. _____
Book No. _____
Series of 2010.
AFFIDAVIT OF LOSS
I, GIL GILAYO, of legal age, Filipino citizen, married and a resident of Lapu-
lapu City, Philippines, after having duly sworn to in accordance with law, do hereby
depose and say:
1. That I am one of the board of directors and an employee of T&H Furnishing

Industries, Inc.;
2. That our company owned and possessed one (1) unit Mazda B2200 double cab
with Plate No. GGW619 that we sold to James C. Candia;
3. That the cancelled Chattel Mortgage, Certificate of Registration bearing No.

08178414 and the Promissory Note for the said vehicle was kept in our office in
Tsuneishi Heavy Industries (Cebu), Inc. in Buanoy, Balamban, Cebu;
4. That unfortunately however, our clerk who kept those documents can no longer
locate the same;
5. That inspite of my efforts to locate the said documents, the same cannot be found,

_____________________ at Balamban, Cebu.
GIL GILAYO
Affiant

affiant exhibiting to me her Community Tax Certificate No. ______________ issued on
______________________ at __________________, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, MA. DAHLIA R. TRIBUNALO, of legal age, Filipino citizen, married and a

resident of Luca, Balamban, Cebu, Philippines, after having duly sworn to in accordance
1. That I am the Lead Teacher of C. Pepito Elementary School, Luca, Balamban,

Cebu;
2. That I purchased from Maharlika Educational Supply school supplies for our
school under Invoice No. 3501 and Official Number 2295;
3. That unfortunately however, I misplaced the said Invoice and Official Receipts
4. That inspite of my efforts to locate the said receipts, the same cannot be found,

_____________________ at Balamban, Cebu.
MA. DAHLIA R. TRIBUNALO

Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, JUCARD DE LA PEÑA, of legal age, Filipino citizen, single and a resident of

Tajao, Pinamungajan, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of DMD Construction assigned at Tsuneishi Heavy

Industries (Cebu), Inc. (THICI) at Buanoy, Balamban, Cebu;
2. That on January 4, 2011, I lost my DMD ID and THICI RF ID when I was on my

way to work at THICI on board tricycle for hire;
6. Further deposed sayeth none.1

_____________________ at Balamban, Cebu.
JUCARD DE LA PEÑA
Affiant

affiant exhibiting to me his Community Tax Certificate No. ______________issued on
______________at ___________________ Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, ERWIN C. NIÑAL, of legal age, Filipino citizen, married and a resident of

Buanoy, Balamban, Cebu, after having duly sworn to in accordance with law, do hereby
depose and say:
1. That I am a On-Job-Trainee of Metaphil International, Inc. and assigned at

Tsuneishi Heavy Industries (Cebu) Inc. situated at Buanoy, Balamban, Cebu;
3. That unfortunately however, I lost my ID when I was on my way home from work
last December 29, 2010;

_____________________ at Balamban, Cebu.
ERWIN C. NIÑAL
Affiant

________________ at Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, BRIANYL MARIE B. MAPA, Filipino citizen, of legal age, and a resident of

Sta. Cruz, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
7. That I college student of University of Cebu taking up Bachelor of Science in

Nursing;
8. That I had been issued a School ID by the said university;
9. That unfortunately however, the said ID was lost when I was on my way home to
Balamban, Cebu sometime in May 2009;
10. That I exerted efforts to locate the said ID but turned futile and consider it lost and
beyond recovery;

________________________ at Balamban, Cebu.
BRIANYL MARIE B. MAPA

Affiant

No. ______________ issued on __________________ at Balamban, Cebu, Philippines.
Doc. No. _____

Page No. _____
Book No. _____
Series of 2009.
AFFIDAVIT OF LOSS
We, spouses FLORENTINO GUTIERREZ and JUANITA M. GUTIERREZ, of

legal ages, Filipino citizens, and residents of Baliwagan, Balamban, Cebu, Philippines,
after having duly sworn to in accordance with law, do hereby depose and say:
1. That we are Senior Citizens;
2. That I, JUANITA M. GUTIERREZ is keeping the Senior Citizen ID of my

husband, together with my ID;
3. That unfortunately however I misplaced our Senior Citizen’s IDs somewhere in

our house;
4. That we exerted efforts to locate the said ID, by our efforts turned futile,
consequently, we now consider it lost and beyond recovery;
5. That we are executing this affidavit to attest the veracity of the foregoing facts
and for legal purposes and intents;

_____________________ at Balamban, Cebu.
FLORENTINO GUTIERREZ JUANITA M. GUTIERREZ

Affiant Affiant

at Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, ZENAIDA M. MANABAT, of legal age, Filipino citizen, married and a

resident of Pulo Baliwagan, Balamban, Cebu, Philippines, after having duly sworn to in
1. That I am a member of Social Security System (SSS) with ID No. 06-1432687-9
2. That sometime on January, 2009, I misplaced my wallet which contain my SSS

ID somewhere in our house;
3. That inspite of my efforts to locate my wallet with my SSS ID, the same cannot
be found;

_____________________ at Balamban, Cebu.
ZENAIDA M. MANABAT
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, ROLITO K. IPILI, of legal age, Filipino citizen, married and a resident of

Hinolawan St., Poblacion, Toledo City, after having duly sworn to in accordance with
1. That I am an employee of Fantaztic Manpower Services, Corporation (FMSC)

assigned at Tsuneishi Heavy Industries (Cebu) Inc. situated at Buanoy, Balamban,
Cebu;
2. That on February 1, 2011, I lost my FMSC ID and CIPDI when I was on my way
home from work at THICI;

_____________________ at Balamban, Cebu.
ROLITO K. IPILI
Affiant

affiant exhibiting to me his Community Tax Certificate No. ________________ issued
on ___________________ at _________________Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, JOEL C. POGOY, Filipino citizen, of legal age, married and a resident of Looc
1. That on September 2, 2009, I lost a bunch of Identification Cards, namely

FISHER Comprehensive Security Services and Systems Corporation ID, CIPDI
ID and Security License that were clipped together with an ID strap and hanged
around my neck;
2. That the said ID’s fell off from my neck unnoticed, may be due to loose clamp of
the ID strap somewhere in the vicinity of Tsuneishi Heavy Industries (Cebu), Inc.
at Buanoy, Balamban, Cebu where I am presently assigned;
3. That I exerted efforts to locate the said IDs, but my efforts turned futile,
consequently, I now consider it beyond recovery;

________________________ at Balamban, Cebu.
JOEL C. POGOY
Affiant

Doc. No. _____

Page No. _____
Book No. _____
Series of 2009.
AFFIDAVIT OF LOSS
I, JINKY S. BERONIA, Filipino citizen, of legal age, and a resident of Salngan,

Passi City, Ilo-ilo, Philippines, after having duly sworn to in accordance with law, do
13. That I am married to Staff Sgt. Rodrigo I Beronia, Jr., Philippine Army;
14. That I had been issued a Military Dependent ID by Philippine Army;
15. That unfortunately however, on February 5, 2009, I lost my wallet which contain
the Military Dependent ID, Voter’s ID and ILECO II Membership ID when I was
in Balamban Public Market, Balamban, Cebu;
16. That I exerted efforts to located the said bag with all its contents, but my efforts
turned futile, consequently, I now consider it beyond recovery;

________________________ at Balamban, Cebu.
JINKY S. BERONIA
Affiant

Doc. No. _____

Page No. _____
Book No. _____
Series of 2009.
AFFIDAVIT OF LOSS
I, FRELEN C. CARMELOTES, Filipino citizen, of legal age, single and a

22. That I graduated from Buanoy National High School last School Year 2000 -
2001;
23. That I had been issued a Diploma upon graduation;
24. That unfortunately however, I inadvertently misplaced the said Diploma

25. That I exerted efforts to locate for the said Diploma, but to no avail, consequently
in now consider it lost and beyond recovery;

________________________ at Balamban, Cebu.
FRELEN C. CARMELOTES
Affiant

No. 20664971 issued on February 18, 2010 at Balamban, Cebu, Philippines.
Doc. No. _____

Page No. _____
Book No. _____
Series of 2010.
AFFIDAVIT OF LOSS
I, BERNARDO AGUELO, JR., of legal age, Filipino citizen, single and a resident
of Abucayan, Balamban, Cebu, Philippines, after having duly sworn to in accordance
6. That I am a client of Banco Maximo, Balamban Branch, Baliwagan, Balamban,

Cebu;
7. That I had been issued a Bank Book by the said bank;
8. That unfortunately however, I misplaced the said Bank Book somewhere in our
house;
9. That I exerted extra efforts to locate for the said Bank Book but the same cannot
be found consequently, I now consider it lost and beyond recovery;

_____________________ at Balamban, Cebu.
BERNARDO AGUELO, JR
Affiant

affiant exhibiting to me his Community Tax Certificate No. 07753185 issued on March
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, EMMA D. NAVARRO, of legal age, Filipino citizen, widow and a resident of

12. That I am the wife of the late PACIFICO P. NAVARRO who was a client and a
holder of ATM Card Plus from Union Bank;
13. That I kept the said ATM Card after his death on December 16, 2008;
14. That unfortunately however, I misplaced the said ATM Card somewhere in our
house;
15. That I exerted extra efforts to locate for the said ATM Card but the same cannot
be found consequently, I now consider it lost and beyond recovery;

_____________________ at Balamban, Cebu.
EMMA D. NAVARRO
Affiant

_________________ at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
Province of Cebu ...………) S.S.
Municipality of Asturias )
AFFIDAVIT OF LOSS
I, APRIL DAWN T. LAZARTE , Filipino citizen, 16 years old, single and a

resident of Poblacion, Balamban, Cebu, Philippines, after having duly sworn to in
1. That I am a Fourth year student of Saint Francis Academy, Balamban Cebu ;
2. That I had been issued a School ID by the said academy;
3. That on June 20, 2011, I lost the said ID while I was on my home from school;

_________________ at Balamban, Cebu.
APRIL DAWN T. LAZARTE

Affiant
With father’s consent:
ROELITO LAZARTE

Doc. No. __________
Page No. __________
Book No. __________
Series of 2011
AFFIDAVIT OF LOSS
I, MARK ANTHONY L ATAMOSA, of legal age, Filipino citizen, married and a

resident of San Isidro, Asturias, Cebu, Philippines, after having duly sworn to in
18. That I am an employee of ANS CONTRACTOR AND CONSTRUCTION

assigned at Tsuneishi Heavy Industries (Cebu) Inc. situated at Buanoy, Balamban,
Cebu;
19. That sometime on last week of January, 2009, I lost my ANS ID somewhere in
our house;

_____________________ at Balamban, Cebu.
MARK ANTHONY L ATAMOSA

Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, RAUL C. SASING, of legal age, Filipino citizen, married and a resident of

Asturias, Cebu, Philippines, after having duly sworn to in accordance with law, do hereby
depose and say:
1. That I a policy holder of PHIL-CARE OF PHIL-ASIA CARE ASIA PLANS,

INC. with LPA No. 01141;
2. That I had been paying for my monthly contribution from December 2003 up to
December 2008;
3. That unfortunately however, some receipts for my monthly contribution were

misplaced or lost somewhere in our house;
4. That I exerted extra efforts to locate for the missing receipts but my efforts were
turned futile, consequently, I now consider it lost and beyond recovery;

_____________________ at Balamban, Cebu.
RAUL C. SASING
Affiant

Doc. No. _______

Page No. _______
Book No. _______
Series of 2009.
AFFIDAVIT OF LOSS
I, MARIA LEONORA P. SEBLOS, of legal age, Filipino citizen, married and a

7. That I am the wife of Christopher M. Seblos who was an employee of Tsuneishi

Heavy Industries (Cebu), Inc. in Buanoy, Balamban, Cebu;
8. That prior to his departure abroad, he left with me all his pertinent documents
which include among others his THICI ID;
9. That unfortunately however, I misplaced the said ID somewhere in our house;

_____________________ at Balamban, Cebu.
MARIA LEONORA P. SEBLOS

Affiant

Doc. No. _______

Page No. _______
Book No. _______
Series of 2009.
AFFIDAVIT OF LOSS
I, ANGELITO P. LABANON, of legal age, Filipino citizen and a resident of

13. That I am the husband of HILDA N. FERNANDEZ who graduated from St.
Theresa’s College Cebu City last March 1993 with the degree in Bachelor of
Elementary Education;
14. That my wife is now in Canada as Overseas Filipino Worker;
15. That I am the one keeping all her legal documents which include among others
her school ID from St. Theresa’s College;
16. That I keep all our important documents inside our file folder and kept inside
our house;
17. That lately when I checked our file folder, the STC ID of my wife was no longer
in that folder;
18. That I exerted efforts to look for the said ID but turned futile, consequently, I
now consider it lost and beyond recovery;

_____________________ at Balamban, Cebu.
ANGELITO P. LABANON
Affiant

December 16, 2008 at Balamban, Cebu, Philippines.
Doc. No. _______

Page No. _______
Book No. _______
Series of 2008.
AFFIDAVIT OF LOSS
I, JADE PEPITO, of legal age, Filipino citizen, single and a resident of Sta. Cruz,
1. That I am an employee of FBMA Incorporated at Arpili, Balamban, Cebu;
2. That on April 3, 2009, I lost my Company ID when I was working at Vessel

1027 at Engine Room starboard side;

_____________________ at Balamban, Cebu.
JADE PEPITO
Affiant

________________ at Balamban, Cebu, Philippines.
Doc. No. _______

Page No. _______
Book No. _______
Series of 2009.
AFFIDAVIT OF LOSS
I, AURELIO B. BUSACO, of legal age, Filipino citizen, married and a resident of

Vito, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law, do
6. That I am holder of BWI-NCII Certificate having successful passed the

Competency Assessment examination on August 2, 2008 at Technical Education
and Skills Development Authority (TESDA), Toledo City;
7. That on November 26, 2008 while I was having my lunch at one of the
restaurants in Cebu City, I left my file folder which contain my BWI-NCII
Certificate ;
8. That I immediately rush back to the said restaurant, but he said file folder was no
longer there;
9. That exerted extra efforts to locate the same, but turned futile, onsequently, I
now consider it lost and beyond recovery;

_____________________ at __________________, Cebu.
AURELIO B. BUSACO
Affiant

on _____________________ at Balamban, Cebu, Philippines.
Doc. No. _______

Page No. _______
Book No. _______
Series of 2008.
AFFIDAVIT OF LOSS
I, TEODULO JR. R. WASQUIN, of legal age, Filipino citizen, married and a

resident of Lamesa, Balamban, Cebu, Philippines, after having duly sworn to in
1. That I am a member of Social Security System (SSS) with SSS ID No. 06-
1533718-4;
2. That I had been issued an SSS ID by the said agency;
3. That on February 19, 2009, when I was on board a V-Hire from Cebu City to
Balamban, Cebu, and upon reaching at Balamban Bus Terminal, I noticed that
my SSS ID Was no longer in the back pocket of my pants;

_____________________ at Balamban, Cebu.
TEODULO JR. R. WASQUIN

Affiant

affiant exhibiting to me his Community Tax Certificate No. 00936854 issued on March 2,
Doc. No. _______

Page No. _______
Book No. _______
Series of 2009.
AFFIDAVIT OF LOSS
I, ERNESTO ENTINADO, JR. of legal age, Filipino citizen, single and a resident
of San Isidro, Asturias, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of Jose Soberano Builders, Inc. assigned at Tsuneishi

Heavy Industries (Cebu), Inc.;
2. That on June 22, 2009 I lost my JSB ID and Safety ID when I was on my way to
work at THICI;

_____________________ at Balamban, Cebu.
ERNESTO ENTINADO, JR.

Affiant

Doc. No. _______

Page No. _______
Book No. _______
Series of 2009.
AFFIDAVIT OF LOSS
I, ALBERTO D. BONTIA, of legal age, Filipino citizen, married and a resident of

6. That I was a victim of a typhoon Rosing that hit badly our place;
7. That the typhoon caused flooding in our area and my house washed away by the
flood;
8. That all my pertinent documents which includes AG&P ID and the Medical
Certificate, Accident Report, Operating Room Record pertaining to my accident
were among the items that was washed away by the flood;
9. That inspite of my efforts to locate for the said items, the same could not be
found. Consequently, I considered it lost and beyond recovery;

_____________________ at Balamban, Cebu.
ALBERTO D. BONTIA
Affiant

affiant exhibiting to me his Community Tax Certificate No. 07589084 issued on October
Doc. No. _______

Page No. _______
Book No. _______
Series of 2008.
AFFIDAVIT OF LOSS
I, LUISA A. TOLERO, of legal age, Filipino citizen, married and a resident of

Singisng, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
12. That I am the sister of the late Calixto L. Apas who died on October 8, 2008 at
Singsing, Balamban, Cebu;
13. That my late brother was a client of Philippine National Bank – Toledo Branch
and had been issued an ATM Card by the said bank;
14. That my brother handed over the said ATM Card to me for safekeeping;
15. That unfortunately however I misplaced the said ATM Card somewhere in our
house;
16. That inspite of my efforts to locate the said ATM Card, the same cannot be
found, consequently, I now consider it lost and beyond recovery;

_____________________ at Balamban, Cebu.
LUISA A. TOLERO
Affiant

Doc. No. _______

Page No. _______
Book No. _______
Series of 2008.
AFFIDAVIT OF LOSS
I, LORENCE T. ARTES, of legal age, Filipino citizen, single and a resident of

Cabagdalan, Balamban, Cebu, Cebu, Philippines, after having duly sworn to in
1. That I am an employee of Gaisano Sari-sari Store at Poblacion, Balamban, Cebu.;
2. That on April 7, 2010, I lost my Gaisano Sari-sari Store ID while I was on my

home onboard a motorcycle;

_____________________ at Balamban, Cebu.
LORENCE T. ARTES
Affiant

affiant exhibiting to me her Community Tax Certificate No. ___________ issued on
______________, at Balamban, Cebu, Philippines.
Doc. No. _______
Page No. _______
Book No. _______
Series of 2010.
AFFIDAVIT OF LOSS
I, REY MELCHOR C. YBAÑEZ, of legal age, Filipino citizen, single and a

6. That I am an employee of Southern Industrial Gas (SIG) with office at, Buanoy,
Balamban, Cebu;
7. That on October 4, 2008 I lost SIG ID when I was on my way home from work;

_____________________ at Balamban, Cebu.
REY MELCHOR C. YBAÑEZ

Affiant

Doc. No. _______

Page No. _______
Book No. _______
Series of 2008.
AFFIDAVIT OF LOSS
I, JAY NOEL NUFABLE, of legal age, Filipino citizen and temporarily residing
at THI Compound, Buanoy, Balamban, Cebu, Philippines, after having duly sworn to in
11. That I am an employee of Tsuneishi Technical Services Phils., Inc. at WCIP-SEZ,

12. That on October 3, 2008 I lost TTSPI ID bearing No. 218 when I was on my way
to our Staff House from work;

_____________________ at Balamban, Cebu.
JAY NOEL NUFABLE

Affiant

affiant exhibiting to me his Community Tax Certificate No. ____________________
issued on _______________________ at Balamban, Cebu, Philippines.
Doc. No. _______

Page No. _______
Book No. _______
Series of 2008.
AFFIDAVIT OF LOSS
I, RONIE N. PETALCURIN., of legal age, Filipino citizen, single and a resident

1. That I am an employee of ACGI - Metaphil Division and assigned at Tsuneishi

Heavy Industries (Cebu), Inc. located at Buanoy, Balamban, Cebu;
2. That on August 8, 2009, I lost my COMPANY ID when I was on my way home

from work;

_____________________ at Balamban, Cebu.
RONIE N. PETALCURIN
Affiant

Doc. No. _______

Page No. _______
Book No. _______
Series of 2009.
AFFIDAVIT OF LOSS
I, JOSEPH V. DEGAMO, of legal age, Filipino citizen, single and a resident of

1. That I am an employee of Metaphil International, Inc. (MII) assigned at Erection

Department of THICI, Buanoy, Balamban, Cebu;
2. That on February 15, 2011, I lost my MII ID when I was on my way home from
work at THICI;

_____________________ at Balamban, Cebu.
JOSEPH V. DEGAMO
Affiant

affiant exhibiting to me his Community Tax Certificate No. __________________ issued
on __________________ at Balamban, Cebu, Philippines.
Doc. No. _______
Page No. _______
Book No. _______
Series of 2011.
AFFIDAVIT OF LOSS
I, OSCAR D. ALFECHE, of legal age, Filipino citizen, married and a resident of

1. That I am an employee of Fanraztic Marine Corporation assigned at Tsuneishi

Technical Services Philippines, Inc.located at Buanoy, Balamban, Cebu;
2. That I dropped the Company Id and the CIPDI ID that that was issued to me
when I was on my way home sometime on August 30, 2008;

_____________________ at Balamban, Cebu.
OSCAR D. ALFECHE
Affiant

affiant exhibiting to me his Community Tax Certificate No. ___________ issued on
______________________ in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
AFFIDAVIT OF LOSS
I, EDMAR A. ABARIDO, of legal age, Filipino citizen, single and a resident of

1. That I am an On-Job-Trainee of T&F Marine Fabricators, Company, a sub-

contractor of Tsuneishi Heavy Industries (Cebu), Inc., located at Buanoy,
Balamban, Cebu;
2. That I had been issued a Temporary ID by the said company;
3. That on March 5, 2011, I dropped my Temporary ID when I was on my home

from work at THICI;
4. That inspite of my efforts to locate the said Temporary ID, the same cannot be

_____________________ at Balamban, Cebu.
EDMAR A. ABARIDO
Affiant

Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, DIONISIO R. NOYNAY. of legal age, Filipino citizen, married and a resident

of 478 Poblacion, Talisay City, Cebu, Philippines, after having duly sworn to in
7. That I am a Marine Engineer by profession and a holder of Seaman’s Book issued

by MARINA, Metro Manila;
8. That sometime in the second week of January, 2010, while I was on board a Tug
Boat working at Tsuneishi Heavy Industries (Cebu), Inc., Buanoy, Balamban,
Cebu, I noticed that my Seaman’s Book which was placed in my jacket was no
longer there;
9. That I believe that it fell off from my jacket unnoticed, due to strong winds at
sea;
10. That I exerted efforts to locate for the said Seaman’s Book but to no avail,

_____________________ at Balamban, Cebu.
DIONISIO R. NOYNAY
Affiant

_____________in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, IDANETH N. SUBONG, of legal age, Filipino citizen, married and a resident

of Lomboy Abucayan, Balamban, Cebu, Philippines, after having duly sworn to in
13. That I am a dealer of NATASHA products;
14. That I had been issued an ID Card by the said company;
15. That on July 20, 2008, I lost my ID when I was on my way home from Buanoy,
Balamban, Cebu;
16. That inspite of my efforts to locate the said ID’s, the same cannot be found,

_____________________ at Balamban, Cebu.
IDANETH N. SUBONG
Affiant

AFFIDAVIT OF LOSS
I, GLENMAR R. ABADINAS, of legal age, Filipino citizen, married and a

resident of Gas, Balamban, Cebu, Philippines, after having duly sworn to in accordance
1. That I am an employee of MARICO Marine Sandblasting and Allied Services

assigned at Tsuneishi Heavy Industries (Cebu), Inc. located at Buanoy, Balamban,
Cebu;
2. That on April 9, 2009, I lost my MARICO and CIPDI ID when I was on my way
home from THICI;

_____________________ at Balamban, Cebu.
GLENMAR R. ABADINAS
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, DANILO F. LUSTE, of legal age, Filipino citizen, married and a resident of

Prenza, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
6. That I am an employee of DMDM Marine Services assigned at Tsuneishi Heavy

Industries (Cebu), Inc. located at Buanoy, Balamban, Cebu;
7. That on June 15, 2008, I lost my ID when I was on my way to work at THICI;

_____________________ at Balamban, Cebu.
DANILO F. LUSTE
Affiant

affiant exhibiting to me his Community Tax Certificate No. 06065684 issued on May 26,
2008 in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
AFFIDAVIT OF LOSS
I, MARIO S. CANDOLI, of legal age, Filipino citizen, single and a resident of

11. That I am member of HEALTH CARE;
12. That I had been issued a HEALTH CARE ID by the said company;;
13. That unfortunately however, I misplaced the said ID somewhere in our house;

_____________________ at Balamban, Cebu.
MARIO S. CANDOLI
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
AFFIDAVIT OF LOSS
I, XY-ZA MARTINE L. EMPUERTO, of legal age, Filipino citizen, single and a

17. That I am a student of Cebu Doctor’s University, Cebu City;;
18. That I had been issued a Library Card by the said university;
19. That unfortunately however, I misplaced the said Library Card somewhere in our
house;
20. That inspite of my efforts to locate the said Library Card, the same cannot be

_____________________ at Balamban, Cebu.
XY-ZA MARTINE L. EMPUERTO

Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
AFFIDAVIT OF LOSS
I, ROGEN S. MOREJON, of legal age, Filipino citizen, single and a resident of

Nangka, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of JEEB Contractor and Marine Services assigned at

Tsuneishi Heavy Industries (Cebu), Inc. located at Buanoy, Balamban, Cebu;
2. That on January 17, 2011, I lost my JEEB Temporary ID and THICI RF ID,
when I was on my way home from work at THICI;
and for all other legal purposes and intents;

_____________________ at Balamban, Cebu.
ROGEN S. MOREJON
Affiant

January 20, 2011 in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, GERALD C. FERNANDEZ, of legal age, Filipino citizen, single and a resident

1. That I am an employee of T & F Marine Fabricators assigned at Tsuneishi Heavy

2. That I had been issued an RF ID by THICI;
3. That unfortunately, I dropped my THICI RF ID unnoticed last January 6, 2011

when I was inside THICI premises carrying my normal duties;
4. That inspite of my efforts to locate the said RF ID, the same cannot be found,

_____________________ at Balamban, Cebu.
GERALD C. FERNANDEZ
Affiant

on January 2011 at Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, ROSALINA CABUNTAGON, of legal age, Filipino citizen, married and a

resident of Mabugnao, Asturias, Cebu, Philippines, after having duly sworn to in
1. That I am the owner of Velosi Motorcycle with Plate No. GS-2398 with CR No.
94036983;
2. That unfortunately however, I misplaced the Certificate of Registration of the said

motorcycle;
3. That inspite of my efforts to locate the said CR, the same cannot be found,

_____________________ at Balamban, Cebu.
ROSALINA CABUNTAGON
Affiant

affiant exhibiting to me his Community Tax Certificate No. 06066304 issued on May 8,
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
AFFIDAVIT OF LOSS
I, MARIO D. VALENZUELA, of legal age, Filipino citizen, single and a resident

1. That on October 31, 2009 I went to Silay City, Negros Occidental for the long
holiday and to visit the graves of my deceased relatives;
2. That I took a bus from San Carlos City to Bacolod City, but when I disembark
from the bus, I noticed that my wallet was no longer in the back pocket of my
pants;
3. That said wallet contain my METAPHIL ID, SSS ID, SSS E1 and E6 forms and
Voter’s ID;
6. That inspite of my efforts to locate the said wallet with all its contents, the same

_____________________ at Balamban, Cebu.
MARIO D. VALENZUELA
Affiant

November 5, 2009 at Balamban, Cebu, Philippines.
Doc. No. _______

Page No. _______
Book No. _______
Series of 2009.
AFFIDAVIT OF LOSS
I, ALMA V. LOCMAYON, of legal age, Filipino citizen, married and a resident

1. That I am an employee of Sumio Marine Services (SMS) presently assigned at

2. That on January 19, 2010, I lost my SMS ID when I was on my way home from
work at THICI;

_____________________ at Balamban, Cebu.
ALMA V. LOCMAYON
Affiant

___________________ at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2010
AFFIDAVIT OF LOSS
I, JORJAN C. LAWAG, of legal age, Filipino citizen, a resident of Pondol,

6. That I am a OJT from CITE assigned at Tsuneishi Technical Services (Phils.),

Inc. at Buanoy, Balamban, Cebu;
7. That I had been issued an ID and Punch Card by TTSP;
8. That unfortunately however, I misplaced my ID and Punch Card somewhere in

our house;
9. That inspite of my efforts to locate the said ID and Punch Card, the same cannot
be found, consequently, I now consider it lost and beyond recovery;

_____________________ at Balamban, Cebu.
JORJAN C. LAWAG
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
AFFIDAVIT OF LOSS
I, SERITO BINGCOLA, of legal age, Filipino citizen, a resident of STo. Niño,

Toledo City, Philippines, after having duly sworn to in accordance with law, do hereby
depose and say:
12. That I am an employee of CLAN Advance General Services assigned at K&A

Metal Industries (Cebu), Inc. located at Buanoy, Balamban, Cebu;
13. That on March 15, 2008, I lost my CLAN Advance ID and my CIPDI when I was
on may home from K&A;

_____________________ at Balamban, Cebu.
SERITO BINGCOLA
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
Province of Cebu ….……..) S.S.
AFFIDAVIT OF LOSS
I, JOEL S. NAPOLES of legal age, Filipino citizen, a resident of Immaculada

Nangka. Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I bought a Yamaha Motorcycle bearing Plate No. GE 1793 fro, Felipe A.
Pacaña on March 20, 2003;
2. That Mr. Pacaña gave to me the Certificate of Registration and the other pertinent
documents of the said motorcycle upon execution of the Deed of Absolute Sale;
3. That I kept the said documents in my file folder;
4. That unfortunately however, when I checked my file folder, I noticed that the CR
was no longer in my file folder;
5. That inspite of my efforts to locate the said Certificate of Registration, the same
for all the other legal purposes and intents;

_____________________ in Cebu City.
JOEL S. NAPOLES
Affiant

February 4, 2008 in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
Province of Cebu ….……..) S.S.
AFFIDAVIT OF LOSS
I, MANUEL C. GILAMON, JR., of legal age, Filipino citizen, a resident of Sta.

Cruz, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
8. That I bought a Mitsubishi Lancer bearing Plate No. PNT-343 from Danilo Englis
who bought same vehicle from Cherry Grace Sorila;
9. That Danilo Englis handed to me the Certificate of Registration bearing CR No.

55277245 and other pertinent documents of the said vehicle upon payment;
10. That I kept the said documents in my file folder;
11. That unfortunately however, when I checked my file folder, I noticed that the CR
was no longer in my file folder;
12. That inspite of my efforts to locate the said Certificate of Registration, the same
for all the other legal purposes and intents;

_____________________ in Cebu City.
MANUEL C. GILAMON, JR.

Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
City / Province of Cebu …) S.S.
AFFIDAVIT OF LOSS
I, GRACE DEMETRIA, of legal age, Filipino citizen, single and a resident of

17. That I am the owner of one unit motorcycle bearing Plate No. 7D8027;
18. That I kept the Certificate of Registration and the Official Receipt of the said
motorcycle in my file folder;
19. That unfortunately however, when I checked my file folder, the said Certificate of
Registration and OR were no longer in the file folder;
20. That inspite of my efforts to locate the said Certificate of Registration and the OR,
the same cannot be found, consequently, I now consider it lost and beyond
recovery;

_____________________ in Balamban, Cebu, Philippines.
GRACE DEMETRIA
Affiant

affiant exhibiting to me his/her Community Tax Certificate No. ________________
issued on _____________________ at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
AFFIDAVIT OF LOSS
I, ALFREDO A. CUEVA, of legal age, Filipino citizen, a resident of Pondol,

23. That I am an employee of FBMA Marine Inc., Arpili, Balamban, Cebu;
24. That on December 16, 2007, I lost my wallet which contain among others my
FBMA ID and my Professional Driver’s License which was issued by LTO,
Toledo City;
25. That inspite of my efforts to locate the said wallet with my FBMA ID and
Professional Driver’s License, the same cannot be found, consequently, I now
26. That the said Driver’s License has not been confiscated by Police Officer for
traffic violation;
to humbly request FBMA Marine Inc. and LTO for reissuance of new ID and all
the other legal purposes and intents;

_____________________ at Balamban, Cebu.
ALFREDO A. CUEVA
Affiant

December 17, 2007 in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2007
AFFIDAVIT OF LOSS
I, SEGUNDO C. RICAÑA, of legal age, Filipino citizen, single and a resident of

Abucayan, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of ULB Contracting Services, Inc. assigned at THICI, at

2. That on April 10, 2018, I lost my RF ID that was issued by THICI when I was on
my way to work at THICI;
3. That inspite of my efforts to locate the said RF ID, the same cannot be found;
to humbly request ULB Contracting Services, Inc. for the re-issuance of new RF
ID;

_____________________ at Balamban, Cebu.
SEGUNDO C. RICAÑA
Affiant

affiant personally known to me to be the same person who executed the foregoing
affidavit,
Doc. No. ______
Page No. ______
Book No. ______
Series of 2 0 1 8 .
AFFIDAVIT OF LOSS
I, JOSEPH S. ROJAS, of legal age, Filipino citizen, a resident of Pondol,

1. That I am an employee of Brilliant Metal Craft student of Cebu Doctor’s

University, Cebu City;
2. That I am taking the course Rad Tech at the said University;
3. That the Library Card that was issued to me by the said university was misplaced
inside our house;
4. That inspite of my efforts to locate the said Library Card, the same cannot be
to humbly request Cebu Doctor’s University for the re-issuance of new Library
Card;

_____________________ at Balamban, Cebu.
RICK POCHOLO B. PEREZ

Affiant

on ____________________ in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2007
AFFIDAVIT OF LOSS
I, MANUEL M. MILAN, of legal age, Filipino citizen, married and a resident of

1. That I am an employee of Brilliant Metal Craft (BMC) assigned at THICI, at

2. That I had been issued an RF ID by THICI;
3. That on January 5, 2011, I lost my wallet which contain my THICI RF ID and

BIR ID (TIN) when I was on my way home from THICI;

_____________________ at Balamban, Cebu.
MANUEL M. MILAN
Affiant

affiant exhibiting to me his Community Tax Certificate No. ______________issued on
______________in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, JUSTERINI BROOKS M. NGUJO, Filipino citizen, 14 years old, single and a

resident of Baliwagan, Balamban, Cebu, Philippines, after having duly sworn to in
3. That I am a first year student of Saint Francis Academy, Balamban Cebu;
4. That I had been issued an School ID by the said academy;
7. That unfortunately however, I lost my ID when I was on my home sometime in

December 2008;

_________________________________ at Balamban, Cebu.
JUSTERINI BROOKS M. NGUJO

Affiant

AFFIDAVIT OF LOSS
I, BEBE ARCHIE J. NIPAYA, Filipino citizen, of legal age, single and a resident
of Baliwagan, Balamban, Cebu, Philippines, after having duly sworn to in accordance
1. That I graduated from Buanoy National High School – Nangka Extenstion last SY
2004 - 2005;a
2. That I had been issued a report card by the said school upon graduation;
3. That unfortunately however, I misplaced the said Report Card somewhere in our
house;
4. That I exerted extra efforts to locate for the said Report Card but to no avail,

________________________ at Balamban, Cebu.
BEBE ARCHIE J. NIPAYA

Affiant

No. ________________ issued on __________________ at Balamban, Cebu,
Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009.
AFFIDAVIT OF LOSS
I, JUNLYN F. MARGAJA, Filipino citizen, of legal age, single and a resident of

28. That I enrolled as Second Year student of Buanoy National High School during
the SY 2003 - 2004;
29. That I decided to transfer to another school during that school year and I took
back my the Report Card which I used to enroll at BNHS but wasn’t able to enroll
in that same year;
30. That unfortunately however, I misplaced the said Report Card somewhere in our
house;
31. That I exerted extra efforts to locate for the said Report Card but to no avail,

________________________ at Balamban, Cebu.
JUNLYN F. MARGAJA
Affiant

No. 06108436 issued on June 3, 2008 at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
AFFIDAVIT OF LOSS
I, KRIS DARYLL M. ATAMOSA, 16 years old, Filipino citizen, a resident of

Poblacion, Asturias, Cebu, Philippines, after having duly sworn to in accordance with
1. That I a graduating student of St. Francis Academy, Balamban, Cebu school year
2007 -2008;
2. That I had been issued an ID by the said school;
3. That unfortunately however, I lost the said ID somewhere in the school campus
sometime on March, 2007;

________________________ at Balamban, Cebu.
KRIS DARYLL M. ATAMOSA

Affiant

AFFIDAVIT OF LOSS
I, HENRY B. SORIANO, of legal age, Filipino citizen, single and a resident of

Pondol, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
1. That I am an employee of RSJ Services, a subcontractor of Tsuneishi Heavy

Industries (Cebu) Inc. situated at Buanoy, Balamban, Cebu;
2. That on March 29, 2011, I lost my RSJ ID when I was on my way home from
work at THICI;

_____________________ at Balamban, Cebu.
HENRY B. SORIANO
Affiant

affiant exhibiting to me his Community Tax Certificate No. . _____________ issued on
______________ in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of ______
AFFIDAVIT OF LOSS
I, JESLIE D. SARSOZO, of legal age, Filipino citizen, a resident of Community

San Isidro, Asturias, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of Metaphil Industries assigned at Tsuneishi Heavy

Industries (Cebu) Inc. situated at Buanoy, Balamban, Cebu;
2. That sometime February 23, 2008, I lost my ID when I was on my way home
from at THICI;
to humbly request Metaphil Industries for the re-issuance of new ID;
IN WITNESS WHEREOF, I have hereunto affix my signature on this ________

day of February, 2008 at Balamban, Cebu.
JESLIE D. SARSOZO
Affiant

affiant exhibiting to me his Community Tax Certificate No. 05981886______________
issued on February 26, 2008 in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
AFFIDAVIT OF LOSS
I, SHERRYL M. SUBINGSUBING, of legal age, Filipino citizen, single and a

resident of Nangka, Balamban, Cebu, Philippines, after having duly sworn to in
1. That I am a member of Social Security System (SSS) with ID No. 06-2145551-3;
2. That unfortunately however, I lost my wallet which contain among others my

SSS ID somewhere in the municipality of Balamban, Cebu;
3. That inspite of my efforts to locate the said wallet with my SSS ID, the same
cannot be found;

________________ at Balamban, Cebu.
SHERRYL M. SUBINGSUBING
Affiant

affiant exhibiting to me her Community Tax Certificate No. _______________ issued on
___________________ in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
Province/City of Cebu..…) S.S.
AFFIDAVIT OF LOSS
I, ENRIQUE C. VILLARITO, of legal age, Filipino citizen, single and a resident

of Matab-ang, Toledo City, Cebu, Philippines, after having duly sworn to in accordance
1. That I am an employee of JCLEDD PHILS with business address at Maiggit,

Toledo City and presently assigned at Tsuneishi Heavy Industries (Cebu), Inc.
(THICI);
2. That on February 26, 2011, I lost my JCLEDD ID when I was on my way home
board a tricycle from THICI to Matab-ang, Toledo City;

________________________ at ________________________, Cebu.
ENRIQUE C. VILLARITO
Affiant

on ____________________ in _________________________, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, JUNDEL A. MARANGA, of legal age, Filipino citizen, a resident of Buli

Langub, Asturias, Cebu, Philippines, after having duly sworn to in accordance with law,
1. That I am an employee of On-Job-Trainee of JCLEDD PHILS with business

address at Maiggit, Toledo City and presently assigned at Tsuneishi Heavy
Industries (Cebu), Inc. (THICI);
2. That on May 27, 2009, I lost my OJT ID issued by JCledd Phils. when I was on
my way to work at THICI;

________________________ at Balamban, Cebu.
JUNDEL A. MARANGA
Affiant

______________ at Asturias, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, ROQUE M. CABAGTE, of legal age, Filipino citizen, a resident of Buanoy,

1. That I am an employee of ACGI – Metaphil Division assigned at THICI, Buanoy,

Balamban, Cebu;
2. That on August 13, 2008 I lost my ID when I was on my way to home from
work at THICI;

_____________________ at Balamban, Cebu.
ROQUE M. CABAGTE
Affiant

affiant exhibiting to me his Community Tax Certificate No. 06195826 issued on August
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
AFFIDAVIT OF LOSS
I, ROGELIO MAMAC, JR., of legal age, Filipino citizen, a resident of

Baliwagan, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of ROVER MARINE SERVICES assigned at Tsuneishi

Heavy Industries (Cebu), Inc.
2. That on January 29, 2008, I lost my wallet which includes my Company ID when
I was on my way home;
3. That inspite of my efforts to locate the said wallet with my Rover ID, the same
cannot be found;

_____________________ at Balamban, Cebu.
ROGELIO MAMAC, JR.

Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008
AFFIDAVIT OF LOSS
I, REMELO B. SECRETARIA, of legal age, Filipino citizen, married and a

resident of Lingatong Vitol, Balamban, Cebuu, Philippines, after having duly sworn to in
7. That I am an employee of BSF Engineering and Supplies assigned at Tsuneishi

Heavy Industries (Cebu), Inc.
8. That on Arpil 17, 2010, I lost my ID when I was on my way home from THICI;

_____________________ at Balamban, Cebu.
REMELO B. SECRETARIA
Affiant

Doc. No. ______
Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, FAUSTINO VILLAFLOR, JR., of legal age, Filipino citizen, a resident of

Abucayan. Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of ACGI – Metaphil Division and presently assigned at

THICI;
2. That on October 14, 2007, I lost my ID when I was on my way home from
THICI;

_____________________ at Balamban, Cebu.
FAUSTINO VILLAFLOR, JR.

Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2007
AFFIDAVIT OF LOSS
I, RENATO M. PUENTENEGRA, of legal age, Filipino citizen, married and a

resident of Abucayan, Balamban, Cebu, after having duly sworn to in accordance with
1. That I am an employee of JEC METAL WORKS, a subcontractor of Tsuneishi

Heavy Industries (Cebu), Inc. (THICI);
2. That on March 14, 2011, I lost my Company ID, RF ID from THICI and CIPDI
ID when I was on my way to work at THICI;

_____________________ at Balamban, Cebu.
RENATO M. PUENTENEGRA
Affiant

____________________ at Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of ______.
AFFIDAVIT OF LOSS
I, REYNANTE D. SWAN, of legal age, Filipino citizen, married and a resident of

1. That I am an On-Job-Trainee of MILAN VENTURES MARINE SERVICES a

subcontractor of Tsuneishi Heavy Industries (Cebu), Inc. (THICI);
2. That on April 1, 2011, I lost my Milan Ventures Temporary ID when I was on

my way home from work at THICI;
3. That inspite of my efforts to locate my ID, the same cannot be found,

consequently, I now consider it beyond recovery;

_____________________ at Balamban, Cebu.
REYNANTE D. SWAN
Affiant

on _______________________ in Balamban, Cebu, Philippines.
Doc. No. _____

0
Page No. _____
Book No. _____
Series of 2011.
AFFIDAVIT OF LOSS
I, JOSELITO B. CATALONIA, of legal age, Filipino citizen, married and a

1. That I am an employee of Tumulak Shipbuilding Contractor Corporation (TSCC)

assigned at Tsuneishi Heavy Industries (Cebu), Inc. (THICI);
2. That on February 7, 2011, I lost my ID when I was on my way home from work at
THICI;

_____________________ at Balamban, Cebu.
JOSELITO B. CATALONIA
Affiant

Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, EUGENE SUQUIB, of legal age, Filipino citizen, a resident of Luca,

1. That I am an employee of Gaisano Sari-sari Store, Balamban, Ceb;
2. That on October 4, 2006, I lost my ID when I was on my way home from work;

_____________________ at Balamban, Cebu.
EUGENE SUQUIB
Affiant

affiant exhibiting to me his Community Tax Certificate No. 10562215 issued on July 12,
Doc. No. ______

Page No. ______
Book No. ______
Series of 2006
AFFIDAVIT OF LOSS
I, MAGDALINO ABADINAS. of legal age, Filipino citizen, a resident of Pondol,

1. That I am an employee of ASTIR ENGINEERING assigned at Tsuneishi Heavy

2. That I had been issued an ID by the said company;
3. That on July 27, 2007, I lost my ID when I was on my way home from THICI;

_____________________ at Balamban, Cebu.
MAGDALINO ABADINAS
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2007
AFFIDAVIT OF LOSS
I, JOHN LEEMAR M. ESCRIBANO, of legal age, Filipino citizen, single and a

resident of Baliwagan, Balamban, Cebu, after having duly sworn to in accordance with
1. That I am an employee of Dumdum Marine Services (DMS) with business

address at Buanoy, Balamban, Cebu and presently assigned at Tsuneishi Heavy
2. That on January 29, 2011, I lost my DMS ID when I was on my way home from
work;
3. That inspite of my efforts to locate my DMS ID, the same cannot be found and
considered lost and beyond recovery;

_________________________________ at Balamban, Cebu.
JOHN LEEMAR M. ESCRIBANO

Affiant

on ______________________ in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, PABLO S. DACORON, JR.. of legal age, Filipino citizen, single and a resident
1. That I am an employee PEVMAR Industrial Services with business address at

Buanoy, Balamban, Cebu and presently assigned at Tsuneishi Heavy Industries
(Cebu), Inc. (THICI);
2. That on November 27, 2009 I lost my PEVMAR ID when I was on my way

home from THICI;

___________________ at Balamban, Cebu.
PABLO S. DACORON, JR
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, JAKE CARLO P. VILLACENCIO, of legal age, Filipino citizen, single and a

resident of Abucayan, Balamban, Cebu, Philippines, after having duly sworn to in
1. That I am an employee of RDV Electromechanical Services, Inc. with business

address at Sta. Cruz, Balamban, Cebu;
2. That I am assigned at Tsuneishi Heavy Industries (Cebu), Inc., (THICI) Buanoy,

Balamban, Cebu;
3. That sometime in May 2018, I lost my RDV ID while on board a tricycle for hire
going back home from work at THICI;
for re-issuance of the said Identification Card and other legal purposes and
intents;

_____________________ at Balamban, Cebu.
JAKE CARLO P. VILLACENCIO

Affiant

affiant exhibiting to me his UMID CRN: 0111-8630742-2.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2018.
Series of 2010.
AFFIDAVIT OF LOSS
I, GELBERT JABONITA of legal age, Filipino citizen, single and a resident of

Gaas, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
1. That I am an Trainee of Bosconian Network Multi Purpose Cooperative

(BNMPC), Prenza, Balamban, Cebu;
2. That on July 1, 2009 I lost ID when I was on my way to school at Prena,

Balamban, Cebu;

_________________________________ at Balamban, Cebu.
GELBERT JABONITA
Affiant

__________________ at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, NEMESIO G. ALMENTO, Filipino citizen, of legal age, married and a resident

of Nangka, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of employee of X’Formers Inc. and presently assigned at

Tsuneishi Heavy Industries (Cebu), Inc. (THICI);
2. That on April 4, 2009, I lost my X’Former’s ID when I was on my way to work

at THICI;

_____________________ at Balamban, Cebu.
NEMESIO G. ALMENTO
Affiant

April 7, 2009 at Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, NORBERTO B. BARRIATOS, JR., of legal age, Filipino citizen, married and

a resident of Arpili, Balamban, Cebu, Philippines, after having duly sworn to in
1. That I am an employee of Arkbeam Construction Corporation and was assigned at

at Tsuneishi Heavy Industries (Cebu), Inc. (THICI);
2. That I had been issued a ID by the said company;
3. That unfortunately however, I dropped my ID when I was on my way home from

work at THICI last July 7, 2009;
consequently I consider it lost and beyond recovery;

______________________ at Balamban, Cebu.
NORBERTO B. BARRIATOS, JR.,

Affiant

affiant exhibiting to me his Community Tax Certificate No.07786544 issued on April 27,
Doc. No. _________

Page No. _________
Book No. _________
Series of 2009.
AFFIDAVIT OF LOSS
I, LIMBERT E. MAITIM, of legal age, Filipino citizen, a resident of Aliwanay,

1. That I am an employee of employee of Gaisano Sari-Sari Store, Balamban, Cebu;
2. That sometime on August 27, 2007, I lost my ID which was issued to me by the
said store somewhere in the municipality of Balamban, Cebu;

__________________________ at Balamban, Cebu.
LIMBERT E. MAITIM
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2007
AFFIDAVIT OF LOSS
I, QUALA T. YNTIG, of legal age, Filipino citizen, single and a resident of

1. That I am an dealer of Natasha based in Balamban, Cebu;
2. That I had been issued an Identification Card by the said firm;
3. That unfortunately however, I lost the said ID;

_________________________________ at Balamban, Cebu.
QUALA T. YNTIG
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2007
AFFIDAVIT OF LOSS
I, ALBERTO HIMAYA, of legal age, Filipino citizen, a resident of Sta. Cruz,

1. That I am an employee of employee of RISSA INDUSTRIAL SALE, INC. and

presently assigned at Tsuneishi Heavy Industries (Cebu), Inc. (THICI);
2. That on March 4, 2007 I lost my ID when I was on my home from work at

THICI;

_________________________________ at Balamban, Cebu.
ALBERTO HIMAYA
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2007
AFFIDAVIT OF LOSS
I, MARCOS G. SIABOC, of legal age, Filipino citizen, married and a resident of

1. That I was employed with Aboitiz Construction Group, Inc. – Metaphil Division
assigned at THICI, Buanoy, Balamban, Cebu;
2. That I was issued a CLEARANCE upon completion of our phase project

sometime in May 2008;
3. That unfortunately however, I misplaced the said clearance somewhere in our

house;
4. That inspite of my efforts to locate the said CLEARANCE, the same cannot be

_____________________ at Balamban, Cebu.
MARCOS G. SIABOC
Affiant

on ________________ in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, VIRGILIO S. TAN, JR., of legal age, Filipino citizen, a resident of Buanoy.

1. That I am an employee of CLEAT Builders and Marine Services, presently

assigned at Tsuneishi Heavy Industries (Cebu), Inc. (THICI);
2. That on August 15, 2009 I lost my CLEAT ID and CIPDI when I was on my
way home from work at THICI;

_________________________________ at Balamban, Cebu.
VIRGILIO S. TAN, JR.,

Affiant

__________________ in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009
AFFIDAVIT OF LOSS
I, ROGELIO V. TAGPUNO. of legal age, Filipino citizen, a resident of Buanoy,

1. That I am a Project Contract Worker of ACGI – Metaphil Division assigned at

2. That I had been issued a Clearance upon the completion of my work contract with
ACGI sometime on December, 2001;
3. That unfortunately, however, I lost or misplaced the said clearance somewhere in

our house;
4. That inspite of my efforts to locate the said Clearance, the same cannot be found,

_____________________ at Balamban, Cebu.
ROGELIO V. TAGPUNO
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2007.
AFFIDAVIT OF LOSS
I, VICTOR P. TALDO, JR., of legal age, Filipino citizen, single, a resident of

Cansomoroy, Balamban, Cebu, Philippines, after having duly sworn to in accordance
34. That I am On-Job-Trainee of STARWELL MARINE SERVICES assigned at

35. That the Temporary ID that was issued to me was lost last January 16, 2009 when
I was on my way home from work;

_____________________ at Balamban, Cebu.
VICTOR P. TALDO, JR
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009.
AFFIDAVIT OF LOSS
I, LORNA ESTOCE. of legal age, Filipino citizen, a resident of Balamban, Cebu,

Philippines, after having duly sworn to in accordance with law, do hereby depose and
say:
1. That I am an applicant of Smart Wireless Broadband;
2. That I had been issued a receipt upon payment of my SmartBro application;
3. That unfortunately however, I lost misplaced the said receipt somewhere in our
house;
4. That inspite of my efforts to locate the said receipt, the same cannot be found,

_____________________ at Balamban, Cebu.
LORNA ESTOCE
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2007.
AFFIDAVIT OF LOSS
I, ELFRED V. ABELLA, Filipino citizen, of legal age, single and a resident of

Anislag, Toledo City, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am a Project Contract Worker of AR Marine Subcon Services assigned

at THICI, Buanoy, Balamban, Cebu;
2. That my Company ID that was issued to me was lost on March 19, 2010 when
I was on my way home from work at THICI;

_____________________ at Balamban, Cebu.
ELFRED V. ABELLA
Affiant

affiant exhibiting to me his Community Tax Certificate No. issued on February 6, 2010
in Toledo City, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2010.
AFFIDAVIT OF LOSS
I, CRISPIN P. CANO, of legal age, Filipino citizen, a resident of Polo

Baliwagan, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am a Project Contract Worker of MAP ELECTRICAL SERVICES

assigned at THICI, Buanoy, Balamban, Cebu;
2. That unfortunately however, I lost the Temporary Company ID that was issued to
me when I was on my way home;
3. That inspite of my efforts to locate the said Temporary ID, the same cannot be

_____________________ at Balamban, Cebu.
CRISPIN P. CANO
Affiant

affiant exhibiting to me his SSS ID 06-3645702-7.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2018.
AFFIDAVIT OF LOSS
I, ELISEO MALALAY. of legal age, Filipino citizen, a resident of Abucayan,

1. That I am a Project Contract Worker of MARINE SANDBLASTING and

ALLIED SERVICES assigned at THICI, Buanoy, Balamban, Cebu;
2. That the Company ID that was issued to me was lost on July 18, 2007 when I was

_____________________ at Balamban, Cebu.
ELISEO MALALAY
Affiant

affiant exhibiting to me his Community Tax Certificate No. 24948869 issued on July 19,
Doc. No. ______

Page No. ______
Book No. ______
Series of 2007.
AFFIDAVIT OF LOSS
I, SEAN P. PAULIN, of legal age, Filipino citizen, a resident of Arpili,

1. That I am a member of Social Security System (SSS);
2. That I had been issued an SSS ID by the said agency;
3. That unfortunately however, I lost my wallet which contain my SSS ID

somewhere in the Municipality of Balamban;
4. That inspite of my efforts to locate the said wallet with my SSS ID, but the same

_____________________ at Balamban, Cebu.
SEAN P. PAULIN
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009.
AFFIDAVIT OF LOSS
I, JERWIN DALOGDOG. of legal age, Filipino citizen, a resident of Pondol

1. That I am an employee of FBMA Marine Inc. located at Arpili, Balamban, Cebu;
2. That the Company ID that was issued to me was lost on February 8, 2008 when I
was on my way home from work;

_____________________ at Balamban, Cebu.
JERWIN DALOGDOG
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
AFFIDAVIT OF LOSS
I, RHEA G. MORALLAS. of legal age, Filipino citizen, single and a resident of

Abucayan, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I graduated from Buanoy National High School, Buanoy, Balamban, Cebu
during the School Year 2000 - 2001;
2. That I had been issued a High School Diploma upon graduation by the said
school;
3. That unfortunately however, I misplaced the said Diploma somewhere in our

house;
4. That inspite of my efforts to locate the said Diploma, the same cannot be found,

_____________________ at Balamban, Cebu.
RHEA G. MORALLAS
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
AFFIDAVIT OF LOSS
I, MELCHOR A. GREJALDO, of legal age, Filipino citizen, a resident of Pondol,

1. That was an employee of Aboitiz Construction Group, Inc. Metaphil Division and
was assigned at Tsuneishi Heavy Industries (Cebu), Inc. at Buanoy, Balamban,
Cebu;
2. That I had been issued a Clearance when I stopped working with the said
company;
3. That unfortunately however, I misplaced the said Clearance somewhere in our

house;

_____________________ at Balamban, Cebu.
MELCHOR A. GREJALDO
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
AFFIDAVIT OF LOSS
I, EUGINE M. SUBANG. of legal age, Filipino citizen, a resident of Pondol,

1. That I was a Project Contract Worker of ACGI – Metaphil Division assigned at

2. That I had been issued a Clearance upon the completion of my work contract with
ACGI sometime on January 2006;
3. That unfortunately, however, I lost or misplaced the said clearance somewhere in

our house;

_____________________ at Balamban, Cebu.
EUGINE M. SUBANG
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
AFFIDAVIT OF LOSS
I, RAUL A. DURA, of legal age, Filipino citizen, a resident of Timbacol,

Tuburan, Cebu, Philippines, after having duly sworn to in accordance with law, do
1. That I am the principal of Mohon National High School, Mohon, Sugod, Cebu;
2. That unfortunately, I misplaced the DepEd Form 18-A for the School Year 2002-
2003 in which one Jumar H. Bravo was listed on the said form;
3. That inspite of my efforts to locate the said Form 18-A, the same cannot be found,

_____________________ at Balamban, Cebu.
RAUL A. DURA
Affiant

________________ at _________________, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.
City of Cebu...........………) S.S.
AFFIDAVIT OF LOSS
I, JECO T. ARNIBAL, of legal age, Filipino citizen, single and a resident of Sta .
Cruz, Balamban, Cebu, Philippines, after having duly sworn to in accordance with law,
1. That I enrolled at University of San Carlos, Cebu City last SY 2008 – 2009
taking up BCTA;
2. That I had been issued an ID by the said University;
3. That sometime on August, 2009, I lost my wallet containing my USC ID when I

was onboard a V-Hire bound to Balamban from Cebu City;
4. That inspite of my efforts to locate the said ID the same cannot be found,

_____________________ at Balamban, Cebu.
JECO T. ARNIBAL
Affiant

Cebu City, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009.
AFFIDAVIT OF LOSS
I, CHRISTIAN P. MILAN, of legal age, Filipino citizen, a resident of Buanoy,

1. That I was a Project Contract Worker of J-CLEDD Phils. Inc., assigned at THICI,
2. That I had been issued an ID by the said Company;
3. That unfortunately, however, I lost the said ID when I as on my way home from
THICI yesterday, February 5, 2009;

_____________________ at Balamban, Cebu.
BENJIE A. INSIGNE
Affiant

____________________ in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, BENJIE A. INSIGNE, of legal age, Filipino citizen, single and a resident of

Nangka, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of Balamban Construction Co. Ltd., a subcontractor of

2. That on March 4, 2011, I lost my company ID when I was on my way home from
work at THICI;

_____________________ at Balamban, Cebu.
BENJIE A. INSIGNE
Affiant

on _______________________ in Balamban, Cebu, Philippines.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2011.
AFFIDAVIT OF LOSS
I, KIRCK AL Y. CABONITA, of legal age, Filipino citizen, a resident of

Mainggit, Toledo City, Philippines, after having duly sworn to in accordance with law,
1. That I am an employee of Metaphil International Inc. assigned at Tsuneishi Heavy

THICI yesterday, May 13, 2009;

_____________________ at Balamban, Cebu.
KIRCK AL Y. CABONITA
Affiant

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009.

AFFIDAVIT OF LOSS
I, MARCIAL P. ESPERONCE JR., of legal age, Filipino citizen, a resident of

Lamesa, Balamban, Cebu, Philippines, after having duly sworn to in accordance with
1. That I am an employee of Metaphil International Inc. assigned at Tsuneishi Heavy

THICI yesterday, May 22, 2009;

_____________________ at Balamban, Cebu.
MARCIAL P. ESPERONCE JR
Affiant

affiant exhibiting to me his Community Tax Certificate No.___________ issued on
_______________ in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2009.

AFFIDAVIT OF LOSS
I, RICHARD PRANGOS, of legal age, Filipino citizen, a resident of Prenza,
Balamban, Cebu City, Philippines, after having duly sworn to in accordance with law, do
1. That I am an employee of ROBER Contractor assigned at Tsuneishi Heavy

THICI last April 22, 2010;

_____________________ at Balamban, Cebu.
RICHARD PRANGOS
Affiant

_____________________ in Balamban, Cebu, Philippines.
Doc. No. ______

Page No. ______
Book No. ______
Series of 2010.

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Republic of the Philippines)

I, MARIA LABINTA, of legal age, Filipino citizen, single and a resident of

1. That I am a member of Social Security Systems (SSS);

2. That I am paying my contributions at SSS;

4. That unfortunately however, I misplaced my SSS Receipt somewhere in the house

6. That I now consider it lost and beyond recovery;

IN WITNESS WHEREOF, I have hereunto affix my signature on this

SUBSCRIBED AND SWORN to before me this ____________________ at

Doc. No. ________

Page No. ________

Book No. ________

I, MAYBELLINE S. CONDE, of legal age, Filipino citizen, married and a

12. That I now consider it lost and beyond recovery;

14. Further deposed sayeth none.

IN WITNESS WHEREOF, I have hereunto affix my signature on this

SUBSCRIBED AND SWORN to before me this ____________________ at

Doc. No. ________

Page No. ________

Book No. ________

I, CRESANTO SARONA, of legal age, Filipino citizen, single and a resident of

15. That I am an employee of CMI Marine Services, assigned at Tsuneishi Heavy

16. That I had been issued a Emergency hire ID by said company;

19. That I now consider it lost and beyond recovery;

21. Further deposed sayeth none.

IN WITNESS WHEREOF, I have hereunto affix my signature on this

SUBSCRIBED AND SWORN to before me this ____________________ at

Doc. No. ________

Page No. ________

Book No. ________

I, ROSADELIMA O. TAN, of legal age, Filipino citizen, married and a resident

22. That I am the proprietor/manager of LIMA’s Canteen;

26. That I now consider it lost and beyond recovery;

28. Further deposed sayeth none.

IN WITNESS WHEREOF, I have hereunto affix my signature on this

SUBSCRIBED AND SWORN to before me this ________________________ at

Doc. No. ________

I, GENEROSO M. CANASA, JR., of legal age, Filipino citizen, married and a

29. That I am an employee of TSUNETETSU CEBU INC., assigned at of Tsuneishi

33. That I now consider it lost and beyond recovery;

35. Further deposed sayeth none.

IN WITNESS WHEREOF, I have hereunto affix my signature on this

SUBSCRIBED AND SWORN to before me this ________________________ at

Doc. No. ________

Page No. ________

Book No. ________

I, FEBIE O. AÑOSA, of legal age, Filipino citizen, single and a resident of

36. That I am an employee of ASIAN SKILLED HUMAN NETWORK, INC.

37. That I had been issued a ASHNI ID by said company;

40. That I now consider it lost and beyond recovery;

42. Further deposed sayeth none.

IN WITNESS WHEREOF, I have hereunto affix my signature on this

SUBSCRIBED AND SWORN to before me this ________________________ at

Doc. No. ________

Page No. ________

Book No. ________

I, ROLANDO T. BOOC, of legal age, Filipino citizen, married and a resident of

1. That I am the son of the late BONIFACIO T. BOOC;

2. That my late father was a member of Balamban Municipal Federation of Senior