Republic of the Philippines
Province of Mountain) S.S
Municipality of Bontoc
AFFIDAVIT OF LOSS
I, ANITA O. LACADEN, of legal age, Filipino Citizen and a resident of
Barangay Remedios, Cervantes, Ilocos Sur, after having been duly sworn in to
accordance with law, do hereby depos and say:
1. That I am a holder/possessor of Dependent I.D. issued by the Armed Forces of
the Philippines (AFP);
2. That the said identification card was kept in my wallet and while riding a
tricycle from my place Remedios going to the town proper, I did not notice
that my wallet was missing;
3. That I exerted effort to retrieve/locate my wallet containing the said I.D. card
but it turned futile and vain, hence the same is now considered lost and
beyond retrieval;
4. That said wallet where the said I.D. was kept was never surrendered to me or
to any law enforcement agency;
5. That the number of the said Identification Card was R11-E00691;
6. That I am executing this Affidavit to attest the truth of the foregoing
statements and for all legal intents and purposes it may deem serve.
IN WITNESS WHEREOF, I hereunto affix my signature this 28 th day of May 2019.
ANITA O. LACADEN
Affiant
SUBSCRIBED AND SWORN to before me this 28th day of May at Bontoc, Mountain
Province.
Doc. No. _____________
Page No. _____________
Book No. _____________
Series of 2019
