7/27/2019 Tagalog s

1/5

REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.x----------------------------------x

AFFIDAVIT OF LOSS

I, Muchacho Achong,of legal age, Filipino, single and a resident of MetroManila, after having been duly sworn to in accordance with law, depose and

state THAT:

1. On January 31, 2009, I was issued a Philippine Passport by the Department

of Affairs in Manila;

2. Recently, I had tried to look for the said passport but the same could not befound;

3. Despite diligent search and efforts to locate the said passport which contains

my Visa and has a 10 years of validity, I could not find the same such that Ibelieve that it is now lost beyond recovery;

4. As such, I am executing this affidavit to attest to the foregoing facts and tosupport the application for the issuance of a new one in lieu of the one which

was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this July03,2009 in Makati City, Metro Manila, Philippines.

____________________Affiant

GSIS ID No. _____________

SUBCRIBED AND SWORN TO before me

this___________________in _________________, Philippines, affiantexhibiting to me his valid proof of identification.

Doc. No. _____;Page No. _____;Book No. _____;Series of 2013.

7/27/2019 Tagalog s

2/5

REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.x----------------------------------x

AFFIDAVIT OF LOSS

I, Estrelita Licuanan, of legal age, Filipino, single and a resident of #33

San Lopez, Aurora Hill, Baguio City, after having been duly sworn to in

accordance with law, depose and state THAT:

1. On , 2010, I was issued a Philippine Passport by the Department of Affairs inManila;

2. Recently, I had tried to look for the said passport but the same could not be

found;

3. Despite diligent search and efforts to locate the said passport, I could not

find the same such that I believe that it is now lost beyond recovery;

4. As such, I am executing this affidavit to attest to the foregoing facts and to

support the application for the issuance of a new one in lieu of the one whichwas lost.

IN WITNESS WHEREOF, I have hereunto set my hand

this___________________in Makati City, Metro Manila, Philippines.

____________________Affiant

GSIS ID No. _____________

SUBCRIBED AND SWORN TO before me

this___________________in _________________, Philippines, affiantexhibiting to me his valid proof of identification.

Doc. No. _____;Page No. _____;Book No. _____;Series of 2013.

AFFIDAVIT OF LOSS OF IDENTIFICATION CARD

7/27/2019 Tagalog s

3/5

REPUBLIC OF THE PHILIPPINES )

_____________________________ ) SS.

I, Dionisia Campuhan, Filipino, of legal age, single/married to Manny Pacquito, and a resident of

#33 San Lopez, Aurora Hill, Baguio City, after having been duly sworn in accordance with law,

hereby depose and say:

1. That I am a holder of a school/company identification card bearing serial number 22340 issued

by Office of the Senior Citizen Affairs

2. That I used to put said identification card in my bag, among others;

3. That sometime on September 21, 1994 when I arrived home from medication, I discovered

that my senior citizen ID card was no longer in my pouch where I used to place it;

4. That diligent effort to locate the same had proved useless; Despite diligent search and efforts

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for

a replacement of said senior citizen ID card

IN WITNESS WHEREOF, I have hereunto affixed my signature this 01 day of October 1994

at Metro Manila, Philippines.

_________________________________

( Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for_____________________ this ____ day of ____________ 20___. The affiant, whom I identified

through the following competent evidence of identity: (ID type and number), valid from (date)

to (date) issued by (issuing authority), personally signed the foregoing instrument before me

and avowed under penalty of law to the whole truth of the contents of said instrument.

7/27/2019 Tagalog s

4/5

Affidavit of Desistance Rape Case

Republic of the Philippines)Province of_______________)S.S.

City/Municipality of____________)

x - - - - - - - - - x

AFFIDAVIT OF DESISTANCE

I,____________,Filipino, single, with residence__________, under oath allege:

1.That I am the complainant in Criminal Case No.__________for alleged "RAPE" against

accused___________, which case is pending before the Regional Trial Court, Branch______,

_____________City, Philippines;

2.That I signed the aforesaid complaint against accused__________against my will, my

signature in the complaint having been obtained thru force, violence and intimidation done to meby my parents;

3.There is no truth to the allegations contained in my sworn statement executed by me againstmy will on___________at____________, taken by____________. There was no force, violence

or intimidation done against me by said accused___________. I was not forced by him to submit

to his desires. It was all in accordance with my own will, volition and consent that I wentpersonally to him because we love each other and I agree and consent to live with him as my

husband;

4.I therefore respectfully request that the above-mentioned case filed against said___________be

dismissed as in fact I now withdraw my complaint against him and I further manifest under oaththat I am now desisting from testifying against him in Court or in any other government entity or

agency in connection with the said criminal case.

IN WITNESS WHEREOF, I have hereunto set my hand this___________at____________,

Philippines.

AFFIANT

(JURAT)

7/27/2019 Tagalog s

5/5