Republic of the Philippines)
____________________ ) s.s.
AFFIDAVIT OF LOSS
I, ____ Ervin Villarin___, of legal age, Filipino, and a resident of Brgy Walang, Lambunao,
Iloilo, Philippines, after being duly sworn in accordance with law, hereby depose and state:
1. That I am the lawful owner of a __Driver License ID____, bearing _ID Number F05-
123456-78, issued on _July 26, 2924__ issued by _Land Transportation Office
Calinog Iloilo_.
2. On __March 4, 2015_______, I discovered that the said Driver’s License ID_ was
missing from my possession. I believe that it was lost on or about _____March 3,
2025_______ at __Festive Mall Walk Iloilo.
3. Despite diligent efforts exerted to locate the said _Driver’s License______, it has
not been recovered and found.
4. I have not pledged or assigned the said _Driver’s License____, to anyone, and it is
free from any encumbrance.
5. This affidavit is being executed for the purpose of declaring the loss and applying
for ____replacement____________________ in lieu of the one which was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this __March 20,
2025_______ at __Iloilo City Philippines________________________.
_________Ervin Villarin________
Affiant
SUBSCRIBED AND SWORN to before me this ___22nd day of March 2025, affiant
exhibited to me his/her Competent Evidence of Identity by way of a TIN ID 749-567-
234-000______ issued at _Iloilo City Philippines______.
Mary Cleer De la Cruz
Public Attorney
Roll No. 92345
Pursuant to R.A 9406 (PAO LAW)
Doc. No. _____:
Page No. _____:
Book No.______:
Series of ______:
Republic of the Philippines)
____________________ ) s.s.
I/We___________________________________ and _______________________________
of legal age, _______________ (civil status) ______________ (nationality) and a resident
of _________________________________________ and with tel.
no.___________________ after having been sworn to in accordance with the law do
hereby depose and state;
1. That I am/we are the biological father/mother and /or person exercising parental
authority over minor(s) ______________________________________________
________________________________, _________________________________.
2. That the child/children will travel to _______________________ (country) for the
following reason/s _________________________________________________
_________________________________________________________________.
3. That the mentioned child/children will be leaving on __________________________
and stay in the said country for a period of __________________________ and will be
taken care of by ___________________________________________________.
4. That I am/we cannot personally travel with my child/children due to the following
reason/s_________________________________________________________.
5. That I am/we are giving my/our full consent for the minor child/children to travel
abroad accompanied by _______________________________________________.
6. That I/We personally guarantee the financial support of the child/children in the course
of his/her/their travel and stay outside the Philippines and further guarantee that
he/she/they will not in any manner become public ward/s of any authority of any country
he/she/they may happen to pass en route to his/her destination.
7. That this affidavit was executed for the purpose of attesting to the truth of the
foregoing facts and for whatever legal purpose it may serve and
8. Affiant further sayeth naught.
IN WITNESS HEREOF, I have hereunto set my hand this ___th day of _____, 20___ in
_________________, Philippines.
_____________________ ___________________
FATHER MOTHER
SUBSCRIBED AND SWORN to before me this ____________________, affiant exhibited
to me his/her Competent Evidence of Identity by way of __________________ issued
at ______________ on __________________.
Doc. No. __________;
Page No. __________;
Book No. __________;
Series of 2025.
Republic of the Philippines)
____________________ ) s.s.
AFFIDAVIT OF DENIAL
I, ___Erna De la Cruz____________, of legal age. Filipino, married and a resident of
_Brgy Hipgos Lambunao Iloilo____, after having been duly sworn to according to
law, hereby depose and state:
1. That I am a business owner in my capacity as such I enter into
numerous transactions which sometimes would require background
investigation by entities I deal with;
2. That due to the fact that the name __Erna De la Cruz_______________
seems to be very common, I was told that there have been several
namesakes with criminal or derogatory records found in the NBI records, a
copy of which is hereto attached for reference;
3. That I would like to categorically state herein that I have no pending
criminal or civil cases filed against me by any person or entity and that cases
dug up in NBI records are merely namesakes and none of them are actually
mine;
4. That further, I wish to refute herein that I am the person with pending
court cases as my middle name is "_Casaquite___" and I am married to "
Clemente De la Cruz__" and have been a resident of the above address for
more than _30__ years now and have never been a resident of any of the
addresses mentioned in the attached NBI records;
5. That I am executing this affidavit in order to attest to the veracity of the
foregoing circumstances and for the purpose of denying herein that I am the
same person referred to in the said list of ____NBI records_____________.
IN WITNESS WHEREOF, I have hereunto set my hand this _4th__day of
__February__________, 2025 at the City of ___Iloilo___________, Philippines.
_____Erna De la Cruz_____
Affiant
SUBSCRIBED AND SWORN to before me this __ day of ___________ 2013, affiant
exhibited a competent proof of their Identity:
Govt. Issued I.D. Valid Until
__________________ _______________________
________________
Notary Public
Doc. No. __________;
Page No. __________;
Book No. __________;
Series of 2025.
