Republic of the Philippines)
Quezon City
) S.S
AFFIDAVIT OF LOSS
I, LUMBAYAN BAGANIA SUWALAWAN, of legal age, Filipino Citizen and a
resident of 326 ELIZONDO ST., QUIAPO MANILA after having been duly sworn to in
accordance with law, hereby depose and say:
1. That, I am the owner/holder of a wallet containing the following items:
a. Philippine Army Military ID
b. Senior Citizen ID
c. Philhealth ID
d. Department of National Defense - Unified ID
e. Cash amount of PHP 900
f. Military Retirement Order dated 20 March 2012
g. Photocopy of the above-mentioned items
2. That in the morning of July 27, 2023 I went to the Veterans Memorial Medical
Center Ophthalmology for check-up for my eyes. Upon leaving, I noticed
that the said items were lost/missing and despite diligent efforts to
find/recover the said items, these could no longer be found/recovered;
3. That I am executing this affidavit to attest to the veracity of my statements,
in support of my request for replacement of my lost items and for whatever
legal purpose it may serve;
IN WITNESS WHEREOF, I hereunto affix my signature this July 28th, 2023 at Quezon
City.
LUMBAYAN BAGANIA SUWALAWAN
Affiant
SUBSCRIBED AND SWORN to before me this July 28th, 2023, at Quezon City, affiant
exhibiting to me his/her competent evidence of identity.
Doc No. ________;
Page No. ______ ;
Book No. _______;
Series of 2023