Republic of the Philippines)

Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, _JERRY N. BALAGAN_, of legal age, married, Filipino and a resident of

503 Dangaran, St. Buntun, Tuguegarao City, Cagayan__ after having been duly sworn

to in accordance with law, do hereby depose and say that:

1. I am a bonafide holder of Land Bank of the Philippines ATM Card SA Number

0306-0171-00 issued by the Land Bank of the Philippines, Tuguegarao City,
Cagayan;

2. On March 29, 2019, I inadvertently loss my Land Bank of the Philippines ATM

Card.

3. After diligent search, my Land Bank of the Philippines ATM Card nowhere to be

found anymore.

4. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing facts and circumstances and for purposes of reporting the loss of my

Policy.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

15th day of October, 2019 at the place first above written.

JERRY N. BALAGAN
Affiant

SUBSCRIBED and SWORN to before me this _____day of

_________________ at Tuguegarao City, Cagayan.

_____________________

Notary Public

Doc. No. ______________

Page No. _______________
Book No ______________
Series of 2019 __________
Republic of the Philippines)
Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, _ALEJANDRO S. ABELLA_, of legal age, married, Filipino and a resident of

_32 Libertad St., Centro Southwest, Solana, Cagayan__ after having been duly sworn to

in accordance with law, do hereby depose and say that:

5. I am a bonafide holder of Policy Contract Number CM00004133877 issued by

the Government Service Insurance System, Tuguegarao City, Cagayan;

6. On September 17, 2018, I inadvertently loss my Policy Contract.

7. After diligent search, my Policy Contract nowhere to be found anymore.

8. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing facts and circumstances and for purposes of reporting the loss of my

Policy.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

23rd day of October, 2018 at the place first above written.

ALEJANDRO S. ABELLA
Affiant

SUBSCRIBED and SWORN to before me this ____day of _________________

at Tuguegarao City, Cagayan.

_____________________

Notary Public

Doc. No. ______________

Page No. _______________
Book No ______________
Series of 2018 __________
Republic of the Philippines)
Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, FERNANDO M. OLONAN, of legal age, married, Filipino and a resident of

Purok 4, San Manuel, Naguilian, Isabela after having been duly sworn to in accordance

with law, do hereby depose and say that:

9. I am a bonafide holder of Policy Contract Number CM00002478014 issued by

the Government Service Insurance System, Tuguegarao City, Cagayan;

10. On July 6, 2018, I inadvertently loss my Policy Contract.

11. After diligent search, my Policy Contract nowhere to be found anymore.

12. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing facts and circumstances and for purposes of reporting the loss of my

Policy.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

9th day of July, 2018 at the place first above written.

FERNANDO M. OLONAN
Affiant

SUBSCRIBED and SWORN to before me this ____day of _________________

at Tuguegarao City, Cagayan.

_____________________

Notary Public

Doc. No. ______________

Page No. _______________
Book No ______________
Series of 2018 __________
Republic of the Philippines)
Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, JAIME A. CASTILLEJOS, of legal age, married, Filipino and a resident of

Barangay Kayvaluganan, Basco, Batanes, after having been duly sworn to in accordance

with law, do hereby depose and say that:

13. I am a bonafide holder of PRC License card _36938__ issued by the

Professional Regulatory Commission, Manila.

14. On June 13, 2017, I inadvertently loss my PRC License card.

15. After diligent search, my PRC License card nowhere to be found anymore.

16. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing facts and circumstances and for purposes of reporting the loss of my

PRC License card to the Professional Regulatory Commission and requesting the

said office to grant me a new PRC License card in lieu of the loss one.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

19th day of June, 2017 at the place first above written.

JAIME A. CASTILLEJOS
Affiant

SUBSCRIBED and SWORN to before me this __19th__day of June 2017 at

Tuguegarao City, Cagayan.

_____________________

Notary Public
Doc. No. ______________

Page No. _______________

Book No ______________

Series of 2017 __________

Republic of the Philippines)

Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, GILBERT P. UBANDO, of legal age, single, Filipino and a resident of

Barangay Capo, Ilagan, Isabela, after having been duly sworn to in accordance with law,

do hereby depose and say that:

17. I am a bonafide holder of ATM card 3707-0595-58 issued by the Land Bank of

Philippines, Carig Tuguegarao Branch, Tuguegarao City, Cagayan.

18. On January 24, 2017, I inadvertently loss my LBP ATM card.

19. After diligent search, my LBP ATM card was nowhere to be found anymore.

20. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing facts and circumstances and for purposes of reporting the loss of my

LBP ATM card to the Land Bank of Philippines and requesting the said office to

grant me a new LBP ATM card in lieu of the loss one.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

25th day of January, 2017 at the place first above written.

GILBERT P. UBANDO
Affiant

SUBSCRIBED and SWORN to before me this _________day of January 2017 at

Tuguegarao City, Cagayan.

 _____________________

Notary Public

Doc. No.
Page No.
Book No.
Series of 2017

Republic of the Philippines)

Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, _____________________, of legal age, married, Filipino and a resident of

_________________________________ after having been duly sworn to in accordance

with law, do hereby depose and say that:

1. I am the wife of the late Mr. Roberto R. Agcaoili an Policy Contract No. CM-

4111759 issued by the Government Service Insurance System, Tuguegarao

Branch, Carig Sur, Tuguegarao City, Cagayan.

2. I inadvertently misplaced and lost the said original Policy Contract No. CM-

4111759.

3. After diligent search, the Policy Contract No. CM-4111759 was nowhere to be

found anymore.

4. I am executing this affidavit to attest to the truth and veracity of the foregoing

facts and circumstances and for purposes of reporting the loss of the Policy

Contract No. CM-4111759 to the Government Service Insurance System,

Tuguegarao City branch office and requesting the said office the one lost.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

6th day of May, 2016 at the place first above written.

LUCY L. AGCAOILI
Affiant
 SUBSCRIBED and SWORN to before me this 6th day of May, 2016 at

Tuguegarao City, Cagayan.

_______________________

Notary Public

Doc. No.
Page No.
Book No.
Series of 2016

Republic of the Philippines)

Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, MRS. NERIE D. BUENO, of legal age, married, Filipino and a resident of 96 M.

Roxas Road, Lower Brookside, Baguio City after having been duly sworn to in

accordance with law, do hereby depose and say that:

5. I am the wife of the late Mr. Roberto R. Agcaoili an Policy Contract No. CM-

4111759 issued by the Government Service Insurance System, Tuguegarao

Branch, Carig Sur, Tuguegarao City, Cagayan.

6. I inadvertently misplaced and lost the said original Policy Contract No. CM-

4111759.

7. After diligent search, the Policy Contract No. CM-4111759 was nowhere to be

found anymore.

8. I am executing this affidavit to attest to the truth and veracity of the foregoing

facts and circumstances and for purposes of reporting the loss of the Policy

Contract No. CM-4111759 to the Government Service Insurance System,

Tuguegarao City branch office and requesting the said office the one lost.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

6th day of May, 2016 at the place first above written.

LUCY L. AGCAOILI
Affiant
 SUBSCRIBED and SWORN to before me this 6th day of May, 2016 at

Tuguegarao City, Cagayan.

_______________________

Notary Public

Doc. No.
Page No.
Book No.
Series of 2016

Republic of the Philippines)

Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, MRS. LUCY L. AGCAOILI, of legal age, widower, Filipino and a resident of

Gattaran, Cagayan after having been duly sworn to in accordance with law, do hereby

depose and say that:

9. I am the wife of the late Mr. Roberto R. Agcaoili an Policy Contract No. CM-

4111759 issued by the Government Service Insurance System, Tuguegarao

Branch, Carig Sur, Tuguegarao City, Cagayan.

10. I inadvertently misplaced and lost the said original Policy Contract No. CM-

4111759.

11. After diligent search, the Policy Contract No. CM-4111759 was nowhere to be

found anymore.

12. I am executing this affidavit to attest to the truth and veracity of the foregoing

facts and circumstances and for purposes of reporting the loss of the Policy

Contract No. CM-4111759 to the Government Service Insurance System,

Tuguegarao City branch office and requesting the said office the one lost.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

6th day of May, 2016 at the place first above written.

LUCY L. AGCAOILI
Affiant
 SUBSCRIBED and SWORN to before me this 6th day of May, 2016 at

Tuguegarao City, Cagayan.

_______________________

Notary Public

Doc. No.
Page No.
Book No.
Series of 2016

Republic of the Philippines)

Province of Cagayan )
Tuguegarao City )

AFFIDAVIT OF LOSS

I, NERIE D. BUENO, of legal age, married, Filipino and a resident of 96 M. Roxas

Road, Lower Brookside, Baguio City, after having been duly sworn to in accordance with

law, do hereby depose and say that:

21. I am a bonafide holder of UMID card issued by the Union Bank, Baguio City.

22. On April 15, 2016, I inadvertently misplaced my UMID card.

23. After diligent search, my UMID card was nowhere to be found anymore.

24. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing facts and circumstances and for purposes of reporting the loss of my

UMID card to the Union Bank and requesting the said office to grant me a new

UMID card in lieu of the misplaced one.

IN TRUTH WHEREOF, I have hereunto set my hand and affix my signature this

9th day of June, 2016 at the place first above written.

NERIE D. BUENO
Affiant

SUBSCRIBED and SWORN to before me this _________day of June 2016 at

Tuguegarao City, Cagayan.

 _____________________

Notary Public

Doc. No.
Page No.
Book No.
Series of 2009