affidavit of loss

REPUBLIC OF THE PHILIPPINES)PROVINCE OF _________________: S.S.MUNICIPALITY OF _____________)

AFFIDAVIT OF LOSS WITH UNDERTAKING

I, ARNALDO P. DIZON, of legal age, Filipino, married, with residence and postal address at Km. 101 McArthur Highway, Brgy. Anupul, Bamban, Tarlac 2317, Philippines, after being sworn to in accordance with law, freely depose and say:

THAT

1. I am the registered owner of the motor vehicle described below as, to wit:

MAKE:Mitsubishi - FusoBODY TYPE:DROPSIDESERIES:CANTERDENOMINATION:Utility VehicleFUEL:DIESELPLATE No.:XBF828ENGINE No.:____________________CHASSIS No.:____________________MVFILE No.:131200000232820

2. As proof of ownership of the above described vehicle, I was issued by the Land Transportation Office (LTO), East Avenue, Quezon City, Official Receipt (OR) No. 266976323 as proof of payment and Certificate of Registration (CR) No. 4283584-4 from LTO, Mabalacat Extension Office, Mabalacat, Pampanga;

3. Said documents while in my possession were misplaced and could no longer be found in spite of diligent efforts in locating them;

4. Said documents were not confiscated by any government authorities in violation of R.A. 4136 and other related laws;

5. I shall assume any responsibility or liability if in any event the said documents were used with or without my knowledge for whatever illicit transactions;

6. I am executing this affidavit to attest to the veracity of my statements and to support the same in its request for duplicate copies of the lost OR & CR at the Land Transportation Office, Mabalacat Extension Office, Mabalacat, Pampanga, where it was previously issued;

7. I bind myself criminally, civilly and administratively liable and will assume full responsibility of any 3rd party claim, and I hereby hold the LTO or any of its employees free any liability arising from any claim for damages as a result of the approval of the registration of the motor vehicle and or issuance of the replacement of OR & CR;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 24th day of June 2014 at ____________________________, Philippines.

ARNALDO P. DIZONAffiantTIN: 234-409-680-000

SUBSCRIBED AND SWORN to before me this 24th day of June 2014 at __________________________, Philippines, affiant exhibited to me his Tax Identification Number duly noted above below his name and signature, and is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntarily executed the same and understood all the contents thereof.

WITNESS MY HAND AND SEAL.

Doc. No. ______;Page No. ______;Book No. _____;Series of 2014.

REPUBLIC OF THE PHILIPPINES)PROVINCE OF TARLAC: S.S.MUNICIPALITY OF BAMBAN)

AFFIDAVIT OF LOSS

I, MARICAR LOPEZ DE GUZMAN, of legal age, Filipino, single, with residence and postal address at Brgy. Anupul, Bamban, Tarlac 2317, Philippines, after having been duly sworn to in accordance with law, do hereby depose and say:

THAT

1. Sometime on October 09, 2013, I pawned my 3.10 grams 18k Pulcera Rope with the Cebuana Lhuillier Pawnshop, Bamban Branch, Bamban, Tarlac, Philippines, in the amount of Php4,700.00;

2. Consequently, I was issued a Pawn Ticket by said Cebuana Lhuillier Pawnshop with Pawn Ticket No. 6034856009184 with expiry date of February 03, 2014;

3. On January 15, 2014, I found out that the Pawn Receipt issued to me by Cebuana Lhuillier Pawnshop was missing and all efforts to locate the same has been in vain;

4. I am executing this Affidavit of Loss to attest to the truth of all the foregoing and to manifest under oath that I pawned my 3.10 grams 18k Pulcera Rope with the said Cebuana Lhuillier Pawnshop, Bamban Branch, Bamban, Tarlac 2317, Philippines; and that I inadvertently lost the Pawn Ticket issued to me by Cebuana Lhuillier Pawnshop;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 21st day of January 2014 at Bamban, Tarlac 2317, Philippines.

MARICAR LOPEZ DE GUZMANAffiantPostal ID No. 42181731Valid Until: 06 Oct. 2016

SUBSCRIBED AND SWORN to before me this 21st day of January 2014 at Bamban, Tarlac, Philippines, affiant exhibited to me her positive identification duly noted above below her name and signature, is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged before me that the same is her free act and deed and that she voluntarily executed the same and understood all the contents thereof.

WITNESS MY HAND AND SEAL.ATTY. ARNALDO P. DIZONRoll No. 20706Notary Public-Province of TarlacMy Commission Expires December 31, 2014PTR No. 2877209, 01-03-14, Bamban, TarlacIBP O. R. No. 881746, 01-03-14, Tarlac ChapterMCLE Compliance Certificate No. IV-0022714/12-19-13Doc. No. 170;Page No. 34;Book No. XII;Series of 2014.


AFFIDAVIT OF LOSS

I, JESSICA D. AMURAO, of legal age, Filipino, single, with residence and postal address at Cope Subdivision, Brgy. Alfonso, Concepcion, Tarlac 2316, Philippines, after having been duly sworn to in accordance with law, do hereby depose and say:

THAT

5. I am a registered voter and a holder of a Commission on Election (COMELEC) Identification Card;

6. On December 16, 2013, while I was riding a passenger tricycle at Brgy. San Roque, Tarlac City, I inadvertently lost my hand bag containing my said COMELEC ID and among other things;

7. Since then, I tried to locate and retrieved my said COMELEC ID but all my efforts were in vain;

8. I am executing this Affidavit of Loss to attest to the truth of all the foregoing; to declare the said COMELEC ID issued in my name as lost and null and void, and to request the Commission of Election to issue a replacement for the same;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 14th day of January 2014 at Bamban, Tarlac, Philippines.

JESSICA D. AMURAOAffiantDominican College of TarlacStudent ID No. AB-0173

SUBSCRIBED AND SWORN to before me this 14th day of January 2014 at Bamban, Tarlac, Philippines, affiant exhibited to me her positive identification duly noted above below her name and signature, is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged before me that the same is her free act and deed and that she voluntarily executed the same and understood all the contents thereof.

WITNESS MY HAND AND SEAL.ATTY. ARNALDO P. DIZONRoll No. 20706

Doc. No. 146;Page No. 30;Book No. XII;Series of 2014. Notary Public-Province of TarlacMy Commission Expires December 31, 2014PTR No. 2877209, 01-03-14, Bamban, TarlacIBP O. R. No. 881746, 01-03-14, Tarlac ChapterMCLE Compliance Certificate No. IV-0022714/12-19-13

AFFIDAVIT OF LOSS

I, GISELLE SIBAL-TAKAHASHI, of legal age, Filipino, with residence and postal address at Sitio Mano, Brgy. Anupul, Bamban, Tarlac 2317, Philippines, after being sworn to in accordance with law, freely depose and say: THAT

1.I am the legal and biological mother of minor MIYUKI TAKAHASHI, who was born on November 05, 2011, a copy of her Certificate of Live Birth is hereto attached as Annex A to form an integral part hereof;

2.My daughter MIYUKI is a holder of a Japanese Passport No. MS8921944, issued on December 16, 2011, valid until December 16, 2016, issued by the Ministry of Foreign Affairs of Japan, a copy of which is hereto attached as Annex B to form an integral part hereof;

3.Sometime in August 2012, while I and my daughter was in a restaurant somewhere in Manila, Philippines, I inadvertently left my bag containing my daughter`s Japanese Passport and her milk container;

3.Since then, I tried to locate and retrieved my bag but all my efforts were in vain;

4.I am executing this Affidavit of Loss to attest to the truth of all the foregoing; to declare the aforesaid Japanese Passport of my minor daughter MIYUKI TAKAHASHI with No. MS8921944 as lost and null and void; and to request the Ministry of Foreign Affairs of Japan and the Consulate Office of the Philippines in Japan to issue a replacement for said passport in the name in my minor daughter MIYUKI TAKAHASHI;

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______ day of January 2013 at _____________________, Philippines.

GISELLE SIBAL-TAKAHASHIAffiantPassport No. XX1295711 Valid Until: ____________

SUBSCRIBED AND SWORN to before me this _____ day of January 2013 at _____________________, Philippines, affiant exhibited to me his positive identification duly noted above below his name and signature, known to me and to me known to be the same person who executed foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntary executed the same and understood all the contents thereof.


Doc. No. _____;Page No. _____;Book No. ____;Series of 2013.

REPUBLIC OF THE PHILIPPINES)PROVINCE OF TARLAC : S.S.MUNICIPALITY OF CAPAS)

AFFIDAVIT OF LOSS

I, GAUDENCIO ADLAI A. DIZON, of legal age, Filipino, married to APPLE KAY SANTOS-DIZON, with residence and postal address at No. 100, Brgy. San Roque, Bamban, Tarlac 2317, Philippines, after being sworn to in accordance with law, freely depose and say:

THAT

1. I am a depositor and holder of a Savings Account Passbook with Account No. 504-15-007388-1 of the Rural Bank of Angeles, Capas Branch, Capas, Tarlac;

2. Sometime in March 2012, while I was about to update my Savings Account, I discovered that my said Passbook was missing from the drawer of my dress cabinet where I usually keep the same;

3. Since then, I tried to locate and retrieved my said Passbook but all my efforts were in vain;

4. I am executing this Affidavit of Loss to attest to the truth of all the foregoing; to declare my said Savings Account Passbook No. 504-15-007388-1 of the Rural Bank of Angeles, Capas Branch, Capas, Tarlac, as lost and null and void, and to request the Rural Bank of Angeles, Capas Branch, Capas, Tarlac, to issue a replacement for the same in my name.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 30th day of August 2012 at Capas, Tarlac 2317, Philippines.

GAUDENCIO ADLAI A. DIZONAffiantPostal ID No.: 6578230Valid Until: 05-14-13

SUBSCRIBED AND SWORN to before me this _____ day of August 2012 at Capas, Tarlac, Philippines, affiant exhibited to me his positive identification duly noted above below his name and signature, known to me and to me known to be the same person who executed foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntary executed the same and understood all the contents thereof.

WITNESS MY HAND SEAL.

Doc. No. ____;Page No. ____;Book No. ____;Series of 2012.

REPUBLIC OF THE PHILIPPINES)PROVINCE OF TARLAC : S.S.MUNICIPALITY OF BAMBAN)

AFFIDAVIT OF LOSS

I, WILSON SIBAL, JR., of legal age, Filipino, married, with residence and postal address at Sto. Domingo I, Capas, Tarlac 2315, Philippines, after being sworn to in accordance with law, freely depose and say:

THAT

1. I am a registered member of PhilHealth and a holder of a PhilHealth Membership Identification Card;

2. Sometime in February 2012, while I was at a Supermarket, my PhilHealth ID was inadvertently loss without noticing the same;

3. Since then, I tried to locate and retrieved my PhilHealth ID but all my efforts turned in vain;

4. I am executing this Affidavit of Loss to attest to the truth of all the foregoing, and to request the PhilHealth to declare my PhilHealth ID as lost and null and void, and to issue a replacement for the same.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 9th day of May 2012 at Bamban, Tarlac 2317, Philippines.

WILSON SIBAL, Jr.AffiantDrivers Licence No.: C11-77-027633Valid Until: June 19, 2014

SUBSCRIBED AND SWORN to before me this _____ day of May 2012 at Bamban, Tarlac, Philippines, affiant exhibited to me his positive identification duly noted above below his name and signature, known to me and to me known to be the same person who executed foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntary executed the same and understood all the contents thereof.


ATTY. ARNALDO P. DIZONRoll No. 20706Notary Public-Province of TarlacMy Commission Expires December 31, 2012PTR No. 1555954, 01-02-12, Bamban, TarlacIBP O. R. No. 773829, 01-02-12, Tarlac ChapterMCLE Compliance Certificate No. III-0001473/01-09-09

Doc. No. _____;Page No. _____;Book No. X;Series of 2012.


AFFIDAVIT OF LOSS

I, JULY MOLATO AGUSTIN, of legal age, Filipino, with residence and postal address at Salangi, Capas, Tarlac 2315, Philippines, after being duly sworn to in accordance with law, freely depose and say:

THAT 1. I am the registered owner of the certain motor vehicle, which more particularly described as follows:

MAKE:RUSIYEAR MODEL:2010PLATE No.:6113 RQMOTOR No.:RW152FMHBA601110SERIAL/CHASSIS No.:RWCLXPGA9A9611110

2.Said motor vehicle was issued a Plate No. 6113 RQ by the Land Transportation Authority (LTO).

3.On June 12, 2012, while I was riding said motor vehicle at Brgy. Patling, Capas, Tarlac, upon reaching my point of destination, I was surprise that said plate number was missing;

4.Since then, I tried to locate and retrieved my said motor vehicle`s Certificate of Registration but all my efforts turned in vain;

5.I am executing this Affidavit of Loss to attest to the truth of all the foregoing; to declare the lost Plate No. 6113 RQ as loss and request the Land Transportation Office (LTO) to issue a new one for the same;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 13th day of June 2012 at Bamban, Tarlac 2317, Philippines.

JULY MOLATO AGUSTINAffiantID No.: _____________________Valid Until: _____________

SUBSCRIBED AND SWORN to before me this _____ day of June 2012, affiant exhibited to me his positive identification duly noted above below his name and signature, known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntarily executed the same and understood all the contents thereof.


ATTY. ARNALDO P. DIZONRoll No. 20706

Doc. No. _____;Page No. _____;Book No. X;Series of 2012.Notary Public-Province of TarlacMy Commission Expires December 31, 2012PTR No. 1555954, 01-02-12, Bamban, TarlacIBP O. R. No. 773829, 01-02-12, Tarlac ChapterMCLE Compliance Certificate No. III-0001473/01-09-09

REPUBLIC OF THE PHILIPPINES)PROVINCE OF TARLAC : S.S.MUNICIPALITY OF BAMBAN )

JOINT AFFIDAVIT OF LOSS

We:

ELMER RIVERA, of legal age, Filipino, single, with residence and postal address at 0231 Casmor Phase 1, Mabiga, Mabalacat, Pampanga 2010,

- and -

EDGAR RIVERA, of legal age, Filipino, married to LIZA TUAZON-RIVERA, with residence and postal address at 103 Rizal Avenue, Brgy. San Roque, Bamban, Tarlac 2317, Philippines, after being sworn to in accordance with law, freely depose and say:

THAT

1.We are depositors of ALLIED BANKING CORPORATION, Mabalacat Branch, Mabalacat, Pampanga, where we maintain a US DOLLAR ACCOUNT under the following account numbers, to wit:

a)Account Number 002-327-000-00003278004672, with a deposit in the amount of US DOLLARS: SIX THOUSAND and/100; and

b)Account Number 002-327-000-00003278005199, with a deposit in the amount of THREE THOUSAND (3,000.00) US DOLLAR; 2.On April 14, 2009, we were issued Foreign Currency Certificate of Time Deposit (FXCY CTD) by the Allied Banking Corporation, Mabalacat Branch, Mabalacat, Pampanga, to wit:

a)Account Number 002-327-000-00003278004672/FXCY CTD Number 0075777 in the amount of US DOLLARS: SIX THOUSAND and xx/100 (US$ 5,000.00) with maturity date on April 29, 2010; and

b)Account Number 002-327-000-00003278005199/FXCY CTD Number 0075824 in the amount of US DOLLARS: THREE THOUSAND and xx /100 (US$3,000.00) with maturity date on April 01, 2011;

Photo copies of said FXCY CTD are hereto attached as Annexes A and B respectively, both of which are made integral part hereof;

3.Sometime in November 2010, we inadvertently loss said FXCY CTD and efforts to locate and retrieve the same since then have been in vain;

4.We are executing this Affidavit of Loss to attest to the truth of all the foregoing; to request the ALLIED BANKING CORPORATION, Mabalacat Branch, Mabalacat, Pampanga, to declare said lost FXCY CTD as null and void, and to issue new ones in lieu thereof;

Page 1 of 2IN WITNESS WHEREOF, we have hereunto affixed our signatures this 26th day of January 2011 at Bamban, Tarlac 2315, Philippines.

ELMER RIVERAEDGAR RIVERA AffiantAffiantDrivers License No. 96-094336 Drivers License C01-08-000001 Valid Until: October 11, 2013 Valid Until: 01-18-2013

SUBSCRIBED AND SWORN to before me this 26th day of January 2011 at Bamban, Tarlac, Philippines, affiants exhibited to me their positive identifications duly noted above below their names and signatures, known to me and to me known to be the same persons who executed foregoing instrument and acknowledged to me that the same is their free act and deed and that they voluntary executed the same and understood all the contents thereof.



Doc. No. 440;Page No. 88;Book No. V;Series of 2011.


AFFIDAVIT OF LOSS

I, RICHARD L. TUAZON, of legal age, Filipino, married, with residence and postal address at Brgy. Anupul, Bamban, Tarlac 2317, Philippines, after being sworn to in accordance with law, freely depose and say:

THAT

1. I am a Pre-Paid Subscriber of SMART Communications with Subscriber Identification Module (SIM) and SMART Money Card Number 09302907758;

2. On January 15, 2013, while I was buying in a store at Mabalacat, Pampanga, I accidentally left my cellular phone where my SMART SIM and SMART Money Card with Number 09302907758 was inserted;

3. Since then, I tried to locate and retrieved my said cellular phone but all my efforts turned in vain;

4. I am executing this Affidavit of Loss to attest to the truth of all the foregoing; to declare my SMART SIM and SMART Money Card with Number 09302907758 as lost; and to request the SMART Communications to retain the number of my lost SIM Card to my newly bought SMART SIM Card;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 17th day of January 2013 at Bamban, Tarlac 2317, Philippines.

RICHARD L. TUAZON AffiantSSS ID No. 3344006411

SUBSCRIBED AND SWORN to before me this 17th day of January 2013, affiant exhibited to me his positive identification duly noted above below his name and signature, and is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntarily executed the same and understood all the contents thereof.


ATTY. ARNALDO P. DIZONRoll No. 20706Notary Public-Province of TarlacMy Commission Expires December 31, 2014PTR No. 2221844, 01-02-13, Bamban, TarlacIBP O. R. No. 881657, 01-02-13, Tarlac Chapter

Doc. No. 28;Page No. 06;Book No. XI;Series of 2013.MCLE Compliance Certificate No. III-0001473/01-09-09


AFFIDAVIT OF LOSS

I, SUSAN GABUTAN y ARTATES, of legal age, Filipino, single, with residence and postal address at Lourdes Park, Bamban, Tarlac 2317, Philippines, after being sworn to in accordance with law, freely depose and say: THAT

1. Sometime in the year 1996, I applied for an Overseas Job through an Employment Agency whose main Office is in Ermita, Metro Manila, Philippines;

2. The Manager of said Employment Agency requested me to leave and entrust to her my passport, identification cards, and other equally important documents related to my application for an Overseas Job;

3. Unfortunately, the said Employment Agency suddenly closed, thus, I was not able to retrieve my employment documents, principal among which is my said passport;

4. Since then, all efforts to locate the personnel of said agency and to recover my said employment documents have been in vain;

5. I am executing this Affidavit of Loss to attest to the truth of all the foregoing; to secure a new PASSPORT from the Department of Foreign Affairs; and to declare my lost PASSPORT as null and void. IN WITNESS WHEREOF, I have hereunto affixed my signature this 19th day of October 2009 at Bamban, Tarlac 2317, Philippines.

SUSAN GABUTAN y ARTATESAffiantCTC No.: CCI2009 02162799Issued On: 07-16-09/Bamban, Tarlac

SUBSCRIBED AND SWORN to before me this 19th day of October 2009 at Bamban, Tarlac, Philippines, affiant exhibited to me her positive identification duly noted above below her signature, known to me and to me known to be the same person who executed foregoing Affidavit of Loss and acknowledged to me that the same is her free act and deed and that she voluntary executed the same and understood all the contents thereof.


ATTY. ARNALDO P. DIZONRoll No. 20706

Doc. No. 265;Page No. 53;Book No. IV;Series of 2009.Notary Public-Province of TarlacMy Commission Expires December 31, 2010PTR No. 0011610, 01-05-09, Bamban, TarlacIBP O. R. No. 684972, 01-05-09, Tarlac ChapterMCLE Compliance Certificate No. III-0001473/01-09-09


AFFIDAVIT OF LOSS

I, WILSON SIBAL, JR., of legal age, Filipino, married, with residence and postal address at Brgy. Sto. Domingo I, Capas, Tarlac 2315, Philippines, after being sworn to in accordance with law, freely depose and say:

THAT

8. Sometime on February 2012, while I was riding a Public Utility Jeep route Capas to Tarlac City, my wallet contain my PHILHEALTH Identification Card fell from my hip pocket;

9. Since then, I tried to locate and retrieved my said wallet but all my efforts turned in vain;

10. I am executing this affidavit to attest to the truth of all the foregoing, and to request PHILHEALTH to declare my Identification Card as lost, to declare the same as null and void, and to issue a replacement for the same.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 16th day of April 2012 at Bamban, Tarlac 2317, Philippines.

WILSON SIBAL, Jr.AffiantDrivers Licence No.: C11-77-027633Valid Until: June 19, 2014

SUBSCRIBED AND SWORN to before me this 28th day of May 2011, affiant exhibited to me his positive identification duly noted above below his name and signature, and is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntarily executed the same and understood all the contents thereof.



Doc. No. 478;Page No. 70;Book No. VII;Series of 2011.


AFFIDAVIT OF LOSS

I, ABEL B. MANGUERRA, of legal age, Filipino, married to WILMA AGUILAR-MANGUERRA, with residence and postal address at Brgy. San Rafael, Bamban, Tarlac, Philippines, after being sworn to in accordance with law, freely depose and say:

THAT

1. On September 18, 2009, while I was on my way to work, my wallet fell from my hip pocket containing my Drivers Licence and other equally important identification cards;

2. Since then, I tried to locate and retried my wallet but all my efforts turned in vain;

3. I am executing this affidavit to attest to the truth of all the foregoing and to request the Land Transportation Office to declare my lost Drivers Licence as null and void, and to issue a replacement Drivers License in my favor;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 28th day of September 2009 at Bamban, Tarlac 2317, Philippines.

ABEL B. MANGUERRA AffiantVIN: 6902-0120A-B0367ABM10001-1

SUBSCRIBED AND SWORN to before me this 28th day of September 2009, affiant exhibited to me his positive identification duly noted above below his name and signature, and is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntarily executed the same and understood all the contents thereof.


ATTY. ARNALDO P. DIZONRoll No. 20706Notary Public-Province of TarlacMy Commission Expires December 31, 2010PTR No. 0011610, 01-05-09, Bamban, TarlacIBP O. R. No. 684972, 01-05-09, Tarlac Chapter

Doc. No. ____;Page No. ____;Book No. IV;Series of 2009.


AFFIDAVIT OF LOSS

I, MARK PANGILINAN DE VERO, of legal age, Filipino, single, with residence and postal address at 257 Blk. 2, Brgy. Anupul, Bamban, Tarlac 2317, Philippines, after being sworn to in accordance with law, freely depose and say: THAT

1.On August 29, 2012, at 1:30 oclock in the morning, while I was waiting for a ride along the McArthur Highway at Brgy. Dolores, City of San Fernando, Pampanga, I was approached by an unknown person who immediately declared a holdup and thereafter, forcibly took my bag containing my SM Pampanga Mall Identification (ID) Card, SM Appliance Center ID Card, SM Borrower`s ID, Health Card issued by the City of San Fernando, Pampanga, Cellular Phone with Globe SIM Card No. 0916-310-0445 and Cash;

2.After getting all my valuables, the robber ran away leaving me awe-stricken. To avoid trouble, I did not try to run after him for fear of bodily harm;

3.I am executing this affidavit to attest to the truth of all the foregoing; to request the management of SM Pampanga, SM Appliance Center to declare my lost SM Pampanga Mall ID, SM Appliance Center ID Card, SM Borrower`s Card and my Globe SIM Card as null and void, and to issue a new one in my name. IN WITNESS WHEREOF, I have hereunto affixed my signature this 30th day of August 2012 at Bamban, Tarlac 2317, Philippines.

MARK PANGILINAN DE VERO AffiantDriver`s License No.: C11-08-003532Valid Until: 2013-10-04

SUBSCRIBED AND SWORN to before me this 30th day of August 2012, affiant exhibited to me his positive identification duly noted above below his name and signature, and is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntarily executed the same and understood all the contents thereof.


Doc. No. 320;Page No. 64;Book No. X;Series of 2012.Notary Public-Province of TarlacMy Commission Expires December 31, 2012PTR No. 1555954, 01-02-12, Bamban, TarlacIBP O. R. No. 773829, 01-02-12, Tarlac ChapterMCLE Compliance Certificate No. III-0001473/01-09-09


AFFIDAVIT OF LOSS

I, CRISTINA V. DIZON, of legal age, Filipino, single, with residence and postal address at Sitio Pandan, Brgy. Anupul, Bamban, Tarlac 2317, Philippines, after having been duly sworn to in accordance with law, do hereby depose and say:

THAT

9. Sometime in October 28, 2010, I pawned my Sony Ericson k770i Cellphone with the Cebuana Lhuillier Pawnshop, Bamban Branch, Bamban, Tarlac 2317, Philippines, in the amount of Php1,200.00;

10. Consequently, I was issued a Pawn Ticket by said Cebuana Lhuillier Pawnshop with Pawn Ticket No. 6034856002577 with expiry date of February 28, 2011;

11. Sometime in December 13, 2010, I found out that the Pawn Receipt issued to me by Cebuana Lhuillier Pawnshop was missing and all efforts to locate the same has been in vain;

12. I am executing this Affidavit of Loss to attest to the truth of all the foregoing and to manifest under oath that indeed, I pawned my Sony Ericson k770i Cellphone with the said Cebuana Lhuillier Pawnshop, Bamban Branch, Bamban, Tarlac 2317, Philippines;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 23rd day of December 2010 at Bamban, Tarlac 2317, Philippines.

CRISTINA V. DIZONAffiant SSS ID No.: 02-27602294

SUBSCRIBED AND SWORN to before me this 23rd day of December 2010, affiant is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is her free act and deed and that she voluntarily executed the same and understood all the contents thereof.


ATTY. ARNALDO P. DIZONRoll No. 20706Notary Public-Province of TarlacMy Commission Expires December 31, 2010PTR No. 0708548, 01-05-10 Bamban, TarlacIBP O. R. No. 773667, 01-05-10, Tarlac ChapterMCLE Compliance Certificate No. III-0001473/01-09-09

Doc. No. 780;Page No. 76;Book No. V;Series of 2010.

REPUBLIC OF THE PHILIPPINES)PROVINCE OF TARLAC: S.S.MUNICIPALITY OF BAMBAN )

AFFIDAVIT OF LOSS

I, JUANITO S. ONG, of legal age, Filipino, single, with residence and postal address at San Roque, Bamban, Tarlac 2317, Philippines, after being sworn to in accordance with law, freely depose and say: THAT

1.I am the registered owner of a parcel of land situated at Barrio Mabiga and Mauaque, Municipality of Mabalacat, Province of Pampanga, Philippines, covered and described by Transfer Certificate of Title No. 175638, a copy of which is hereto attached as Annex A and made an integral part hereof;

2.Sometime in January 2011, when I was inquiring at Sun Cellular, Metro Town Mall, Tarlac City, Philippines, I inadvertently left my envelop containing my Transfer Certificate of Title No. 175638, and all efforts to locate the same since then has been in vain; 3.I certify that the ORIGINAL COPY of said TCT is available at the Office of the Register of Deeds of the City of Angeles;

4. I caused the registration of this Affidavit of Loss with the Office of the Register of Deeds of the City of Angeles; 5.I am executing this Affidavit of Loss to attest to the truth of all the foregoing statements, and to secure an Owner`s Duplicate of TCT No. 175638 from the Register of Deeds of the City of Angeles, after proper court proceedings.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 2nd day of May 2011 at Bamban, Tarlac, Philippines.

JUANITO S. ONGAffiantDrivers License No. N05-73-020177Valid Until: 2011-08-16

SUBSCRIBED AND SWORN to before me this 2nd day of May 2011, affiant is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntarily executed the same and understood all the contents thereof.


Doc. No. 319;Page No. 64;Book No. VII;Series of 2011.Notary Public-Province of TarlacMy Commission Expires December 31, 2012PTR No. 1093807, 01-05-11, Bamban, TarlacIBP O. R. No. 773736, 11-19-10, Tarlac ChapterMCLE Compliance Certificate No. III-0001473/01-09-09


AFFIDAVIT OF LOSS

I, NOLAN R. TOLENTINO, of legal age, Filipino, married, with residence and postal address at Brgy. Anupul, Bamban, Tarlac, Philippines, after being sworn to in accordance with law, freely depose and say:

THAT

1. Sometime in the month of July, I bought a 6SM Dyna Power Battery from Winfred Tire Supply located at Angeles City, Pampanga, Philippines, bearing Serial Number 0437551 and with a warranty for 6 months reckoned from July 2008 or up to December 2008.

2. Sometime last July, I inadvertently lost the Official Receipt issued to me by Winfred Tire Supply together with the Warranty Slip and all efforts to locate the same since then up to the present time has been in vain.

3. I am executing this Affidavit of Loss to attest to the truth of all the foregoing and to secure a replacement for said battery to Winfred Tire Supply in pursuant to their warranty. IN WITNESS WHEREOF, I have hereunto affixed my signature this 17th day of September 2008 at Bamban, Tarlac, Philippines.

NOLAN R. TOLENTINO A f f i a n t SSS No. 03-3454617-5

SUBSCRIBED AND SWORN to before me this 17th day of September 2008, affiant is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is his free act and deed and that he voluntarily executed the same and understood all the contents thereof.


ATTY. ARNALDO P. DIZONRoll No. 20706Notary Public-Province of TarlacMy Commission Expires December 31, 2008PTR No. 3926087-J, 01-02-08, Bamban, TarlacIBP O. R. # 684881, 01-02-08, Tarlac Chapter

Doc. No. ____;Page No. ____;Book No. III;Series of 2008.

REPUBLIC OF THE PHILIPPINES)PROVINCE OF TARLAC : S.S.MUNICIPALITY OF CAPAS )

AFFIDAVIT OF LOSS

I, IRENE B. FACUNLA, of legal age, Filipino, single, with residence and postal address at Brgy. Cut-Cut 1st, Capas, Tarlac, Philippines, after being sworn to in accordance with law, freely depose and say: THAT

6. On January 25, 2009, about 10:00 11:00 oclock in the morning, while I was riding a Public Utility Jeepney route Angeles to Mabalacat, Pampanga I inadvertently loss my Allied Bank ATM Card and all efforts to locate the same since then up to the present time has been in vain.

7. I went to the Allied Bank Capas, Tarlac Branch and reported the lost of my ATM Card and requested the officers thereat to block said Allied Bank ATM Card and to declare the same as null and void.

8. I am executing this affidavit to attest to the truth of all the foregoing; to request Allied Bank Capas, Tarlac Branch to declare the lost ATM Card of mine as null and void; and to issue a new one in my name. IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of January 2009 at Capas, Tarlac, Philippines.

IRENE B. FACUNLA A f f i a n tDrivers Licence No. C11-07-007245

SIGNED IN THE PRESENCE OF:____________________________________________

SUBSCRIBED AND SWORN to before me this ____ day of January 2009, affiant is known to me and to me known to be the same person who executed the foregoing instrument and acknowledged to me that the same is her free act and deed and that she voluntarily executed the same and understood all the contents thereof.


Doc. No. _____;Page No. _____;Book No. ____;Series of 2009.

and to issue a new one in my name; that I am willing to surrender the lost ATM Card in the event that the same could be found and located; that I bind myself to hold LANDBANK free and harmless from any loss and damage that my arise or it may incur in connection with the issuance of a new ATM Card; that I am willing to testify before any court of justice to substantiate the truth of each and all of the above said facts;

affidavit of loss

Documents

mabalacat extension

bamban branch

philippinesprovince

said documents

land transportation

motor vehicle

described vehicle

legal age