REPUBLIC OF THE PHILIPPINES
Province of Davao del Sur
Municipality of Bansalan
I, Axl Roose Cinco Batingal, of legal age, single/married, Filipino, and
residing at Purok Cebole, Sitio Sto. Niño, New Clarin, Bansalan,
Davao del Sur, after having been duly sworn to in accordance with law,
hereby depose and state:
1. That I am the holder of a Philippine National ID issued by the
Philippine Statistics Authority (PSA) with ID Number 3183-6071-
3208-6198;
2. That on or about January 07, 2025, I discovered that my National
ID was lost and could no longer be located despite diligent efforts to
find it;
3. That the loss of my National ID was not due to any illegal act or
fraudulent intent on my part;
4. That I am executing this affidavit to attest to the loss of my National
ID and for whatever legal purposes it may serve, including applying
for a replacement with the Philippine Statistics Authority;
5. I am fully aware that any false statement in this affidavit may hold
me liable under applicable Philippine laws.
IN WITNESS WHEREOF, I have hereunto set my hand this [Day] of
[Month, Year], in [City/Municipality], Philippines.
[Your Full Name]
Affiant
SUBSCRIBED AND SWORN to before me this [Day] of [Month,
Year], at [City/Municipality], Philippines, affiant exhibiting to me
his/her valid government-issued ID with details as follows:
ID Type: [Type of ID]
ID Number: [ID Number]
NOTARY PUBLIC
Doc. No. _____
Page No. _____
Book No. _____
Series of _____
