Republic of the Philippines
)
City of Tayabas
) S.S.
Province of Quezon
)
X---------------------------------------------X
AFFIDAVIT OF LOSS
I, AIRENE OSMA CAAGBAY, of legal age, Filipino, married, with residential address at
Barangay Silangang Palale, City of Tayabas, Province of Quezon, Philippines, after having been sworn
to in accordance with law hereby depose and state that:
1. I am the owner of Tulay sa Pag-unlad, Inc. (TSPI) I.D. issued by TSPI Tayabas City Branch
on 2021;
2. In order to secure the said TSPI I.D., I kept it in one of our cabinets at home;
3. Sometime in February 27, 2022, I noticed that the said TSPI I.D. was not found in the cabinet
where I kept the same;
4. I tried to find to it in different areas of my house by my efforts proved futile;
5. Despite my diligent efforts, I can no longer locate the said TSPI I.D. and I have already
considered it to be beyond recovery;
6. I am executing this Affidavit of Loss to attest the truth of the foregoing facts and for any legal
purpose that this may serve.
IN WITNESS WHEREOF, I have hereunto signed this affidavit this 3rd day of March 2022
in Tayabas City, Quezon.
___________________________
AIRENE OSMA CAAGBAY
Declarant
SUBSCRIBED AND SWORN to before me this 3rd day of March 2022 in Tayabas City,
Quezon. The affiant exhibited to me her PhilHealth I.D. No. 08-025147256-8 as competent evidence
of identity.
Doc. No. 206;
Page No. XLII;
Book II;
Series of 2022.